The Clinical Applications of CranioSacral Therapy

By Kailas, LMT, NCTMB, CST, Cert. Ayu. CranioSacral Therapist and Certified Ayurvedic
Clinical Consultant in Los Angeles
The Clinical Applications of CranioSacral Therapy
CranioSacral Therapy encourages the bodys natural healing process through the use of a
gentle touch and very light pressure. The craniosacral system includes our brain, spinal
cord, nerves, and the cerebrospinal fluid surrounding them. When the craniosacral system is
supported through this gentle form of bodywork, the bodys natural healing power is
recharged, and patients experience a wide range of health benefits.
For over 35 years, thousands of practitioners world-wide have demonstrated CranioSacral
Therapy to have many clinical applications, and the practice of CranioSacral Therapy has
evolved into an integrated and highly respected form of therapy. Medical doctors,
osteopaths, chiropractors, occupational and physical therapists, nurses, acupuncturists,
massage therapists, dentists, and family caregivers have trained in CranioSacral Therapy.
The founder, Dr. John Upledger, DO, OMM, has always believed that this simple, noninvasive, therapeutic technique should be available to everyone, and not owned by any
single profession. He has worked to ensure that CranioSacral Therapy is taught with an
attitude of openness to all clinical applications and with respect for each of the healing arts.
Patient-Centered Care
CranioSacral Therapy does not evaluate patients through preconceived models and
expected outcomes. Each patient, regardless of age or ability, is considered the true master
of their therapeutic process, and responsiveness to their needs energizes and guides the
therapy.
Clinical Trials vs. Clinical Outcome
The clinical framework of CranioSacral Therapy is that nothing is impossible. Dr.
Upledger states unequivocally that the clinical outcome of a given patient is the only true
evaluative process. (1) CranioSacral Therapy is more focused on providing care, than
justifying that care through double-blind studies which often provide the answer that,
naturally-based healing is impossible.
In many challenging health situations, CranioSacral Therapy has counteracted the despair
of patients which is often the result of the medical system that offers little hope for many
types of cases and conditions, and misdiagnoses or provides overly-complex diagnoses and
treatments as a matter of routine.
The Ten Step Protocol
CranioSacral Therapy provides a protocol for evaluation and treatment which addresses

90% of craniosacral system dysfunctions. This Ten Step Protocol is non-invasive and based
in light touch, and cannot not harm a patient when practiced as directed. The Ten Step
Protocol was developed through years of clinical experience and research by Dr. John
Upledger, DO, OMM. It can be applied in almost any clinical situation with positive
results.
In keeping with the vision of CranioSacral Therapy, the Ten Step Protocol can be practiced
by anyone who receives training. It does not require the practitioner to have an extensive
background in anatomy and physiology in order to be effective. The Ten Step Protocol is
effective in most cases due to its ability to support the bodys own natural healing ability. It
only requires the practitioner to perform the protocol with a sensitive hand, guided by the
responses which the patients body makes.(2)
Clinical Techniques
The clinical techniques which make up the Ten Step Protocol are: palpation of craniosacral
rhythm, transverse diaphragm release, lumbosacral and sacroiliac release; atlanto-occipital
release, occipital cranial base release, frontal lift, parietal lift, sphenoid compressiondecompression; compression-decompression of the temporomandibular joint, still point and
CV-4; dural tube traction, rock and glide; therapeutic pulse, and direction of energy and Vspread.
Additional CranioSacral Therapy techniques can be performed in concert with the Ten Step
Protocol, or on their own, in any sequence. These are: whole body evaluation (arcing,
facilitated segment, fascial glide); hard palate, facial, and cranial bone lesion releases;
significance detector, positional release, energy cyst release, therapeutic dialog and
imagery, vectors, acupuncture meridian unwinding, chakra balancing, dolphin/aquatic
therapy and SomatoEmotional Release.
While most of the techniques are listed above, CranioSacral Therapy is an unlimited
modality. The beauty is however, that the majority of the principal clinical effects can be
obtained through the gentle therapeutic action of the Ten Step Protocol.
General Clinical Effects
The clinical effects of CranioSacral Therapy are outlined below, indicating the natural
progression of effects as they lead toward greater health and wellbeing.
1. Soft Tissue Release
CranioSacral Therapy promotes the relaxation and release of restrictions and held patterns
in the soft tissues including the fascia and muscle tissue, diaphragms of the pelvis and
thorax, organs and their membranes, nerves, glands, lymphatic and circulatory tissue, and
the spinal and cranial dura and related membranes.
Relaxation of the soft tissue involves their cellular and electrochemical networks,
vasculature, lymphatics, and extra-cellular fluids, allowing the entire myofascial structure

to decompress and regain functional symmetry, releasing energy on all levels, and affecting
all systems of the body.
2. Structural Decompression
CranioSacral Therapy promotes the decompression of musculoskeletal structures, including
joints, symphyses, synchondroses, sutures, and foramena. Decompression reduces articular
surface and intervertebral disc irritation and degradation; pain, including referred pain;
nerve entrapment; and structural musculoskeletal distortions which the body must
accommodate, and which can themselves be causes of additional dysfunction.
Decompression of the jugular and other cranial foramena, and the vertebrae, is directly
addressed through CranioSacral Therapy. The cranial nerves, especially the trigeminal and
vagus, produce significant dysfunction throughout the body when they have been impinged
and burdened by dysfunctions of the membranes and bones of the cranium, including
profound physical, emotional, and developmental problems.
3. Structural Mobilization
CranioSacral Therapy promotes the mobilization of joints, neuromuscular, and organ
structures, improving their balance and functional symmetry. Mobilization brings freedom
to the body, enhances reciprocal enervation, stimulates the nervous and endocrine systems,
and stimulates the bodys needs, affecting metabolism. Motion is health. Need I Say
More? Dr. Upledger has succinctly stated.
4. Fluid Exchange
CranioSacral Therapy promotes fluid exchange among numerous physiological systems. In
fact, if a therapist could choose only one physiological effect resulting from a therapy
session, it would be to, move the fluid, move the fluid, move the fluid!
Fluid exchange distributes nutrients, antibodies, and flushes waste. It lubricates tissue,
contributing to muscle fiber length and strength, and decreasing tissue strain. Vascular and
lymphatic flow, temperature regulation, electrolyte distribution, nervous system function,
and cellular integrity are all enhanced.
CranioSacral Therapy specifically enhances the circulation of cerebrospinal fluid (CSF),
and facilitates the movement of the body in synchrony with the craniosacral rhythm. CSF
has been shown to carry small molecule chelating agents, removing toxic heavy metals
from the central nervous system and preventing deterioration of the basal ganglia and
cortical and subcortical regions of the brain.
5. Energy Exchange
CranioSacral Therapy promotes energy exchange across quantum, microscopic, and
macroscopic levels, and involves numerous biological systems including the psychological

and developmental domains of a patient. The spiritual-energetic domain, if and how a

patient defines it, can fully participate in the expanded energy exchange as well.
The energy exchange produced by CranioSacral Therapy is a readily observable, common
experience for a majority of therapists and patients. Energy is perceived through movement
and sensation in the body, release of heat, pulsing sensations, breathing, sounds and
expressions. The energy exchange produced by CranioSacral Therapy treatment has also
been observed scientifically using electromagnetic measurement, biofeedback and
brainwave measurement; and has been tested through the application of acupuncture
techniques, kirilian photography, and other methods.
But the most important exchange of energy attributed to CranioSacral Therapy is the
restoration of hope, and the progress patients make in their lives.
6. SomatoEmotional Release
CranioSacral Therapy promotes the release of emotional energy which has been mirrored
and retained in our bodies our somato-emotional memory through a process called
SomatoEmotional Release, which may be initiated by a patient at any time during a session.
Through therapeutic dialog and imagery techniques, including accessing the Inner
Physician, guides, and the voices of organs, cells, and other parts of the body, emotional
memories can be brought to the surface, and their often painful charge and associated disease states can be dissipated.
Problems of a chronically recurring nature, and the feelings which reduce the bodys ability
to heal, such as hopelessness and helplessness, frustration, fear, anxiety, apathy, grief,
betrayal, and traumatic incidents, are often resolved through SomatoEmotional Release.
General Clinical Application Types
The clinical applications of CranioSacral Therapy may vary according to the types of
clinical practice required in a given population, and the conceptual framework within which
clinical care is given. The categories listed below represent a few general areas which I
believe are representative of the success which CranioSacral Therapy practice enjoys today.
Pain Management and Recovery
CranioSacral Therapy is effective in reducing and eliminating chronic pain in a wide
spectrum of conditions, and often correcting the underlying dysfunction(4). Its therapeutic
effects on the nervous system reduce chronic sympathetic irritation by balancing the
reticular formation5 (reticular alarm system) and by reducing facilitated spinal segments.
The generally decompressive action of CranioSacral Therapy alleviates nerve pain, referred
pain, and inflammatory pain.

CranioSacral Therapy can prevent the need for invasive surgical interventions and the overreliance on pharmaceuticals. It can be also used post-surgery to normalize traumatized
tissue, promote fluid exchange, and release toxic anesthetics from the nervous system. It is
effective in helping patients get remobilized after a sustained health crisis or injury.
The CV-4 technique is utilized in pain management and can be combined with direction of
energy techniques and positional release. The CV-4 technique induces craniosacral
stillpoint, and may affect the reticular formation due to the proximity of the reticular
formation and the fourth ventricle.
SomatoEmotional Release enhances the effectiveness of pain management by treating the
underlying emotional and experiential causes of pain and chronicity, and can be utilized to
decrease emotional co-morbidities.
Stress and Traumatic Stress
CranioSacral Therapy effectively reduces stress and anxiety through tissue relaxation and
release, lowering blood pressure, improving sleep rest, and reducing sympathetic
hypertonus and irritability.
Electroencephalography (EEG) readings demonstrate that, during craniosacral stillpoint,
theta wave rhythms in the brain increase, producing a mental state of calm passive
awareness(6), which is indicative of a reduction in sympathetic nervous system activity(7).
This most probably includes reduced activity in the reticular formation (reticular alarm
system), which has outputs to the entire central nervous system, plays a critical role in
muscle control, deep tendon reflexes, spasticity, and produces cortisol , the stress hormone(9).
Traumatic stress, including both the emotional and the somatic components, can be treated
in CranioSacral Therapy through the SomatoEmotional Release process. CranioSacral
Therapy has shown that, in physical or emotional trauma, energy impacts and is absorbed
into the body. If the body cannot readily defuse the energy, it quarantines the harmful
impact in an Energy Cyst, which, like any other toxic lump that the body cant eliminate,
may eventually cause dysfunction and disease.
It should be noted that CranioSacral Therapy and SomatoEmotional Release have been
clinically successful in cases of Post Traumatic Stress Disorder (PTSD) and many other
traumatic stress conditions.
Immune System Revitalization
CranioSacral Therapy provides immune system support and revitalization. The burden on
our immune systems includes constant daily stress; pain, bodily accommodations, and pain
suppression; toxic waste, chemicals, emotions and ideas; and the stress of enduring our
immersion in a vast cultural dynamic of enforced ignorance about the nature of immunity,
healing, and health. Its no wonder our immune systems are confused!

However, the immune system can be generally revitalized through the release of soft tissues
and diaphragms, which improves lymphatic function, circulation, digestion, elimination,
and organ function. Exchange of fluids and the resulting detoxification of tissues and
organs can reduce the sensitivity to allergens.
Furthermore, release of the craniosacral system including activating and balancing the
ventricular system of the brain, balancing the activity of the reticular formation, and
energizing the thymus gland can contribute to more efficient immune response.
In the brain the reticular formation secretes cortisol, which suppresses the immune
system(10). Balancing the reticular formation can be achieved through a CV-4 induced
craniosacral stillpoint, direction of energy, therapeutic dialog or SomatoEmotional Release,
resulting in decreased cortisol secretion.
A craniosacral stillpoint also improves the production and circulation of craniosacral fluid,
which carries antibodies and flushes toxins from the central nervous system, improving the
overall function of the central nervous system. Craniosacral stillpoint has been shown to
influence the immune response by reducing acute inflammation, fever, and infection.
Therapeutic dialog and SomatoEmotional Release can increase a patients awareness of
their immune response, and engage the bodys natural ability to heal itself. This natural
intelligence is the cornerstone of wellness and the reversal of the disease process.
Physical Therapy and Rehabilitation
The integration of CranioSacral Therapy with Physical Therapy and other rehabilitation
modalities is extremely successful in clinical practice. CranioSacral Therapy provides an
eclectic, non-deterministic and non-mechanistic approach to musculoskeletal mobilization,
and has excellent therapeutic techniques such as SomatoEmotional Release, direction of
energy, and arcing for energy cysts, which assist a patient to resolve any emotional traumas
and energetic issues which may underlie their condition. In addition, CranioSacral Therapy
empowers patients by supporting their bodys natural power to heal, assists with pain
management, reduces the need for often toxic medications, and helps prevent the need for
invasive surgery.
Obstetric and Pediatric Care
Utilizing CranioSacral Therapy in obstetric care is an excellent method of preventive
healthcare. During pregnancy, soft tissue release, lumbosacral decompression, and
increased fluid exchange balance the mothers body, and help prepare it for the birth
process.
For the newborn, a gentle CranioSacral treatment just after birth can ensure correct
functioning of the craniosacral system and prevent a broad spectrum of dysfunctions. It can
also clear obstetrically induced traumas such as vacuum or forceps induced cranial
compression, and meningeal strain which can occur during the sudden pressure drop that
takes place during a cesarean birth. Induction of the sucking reflex and prevention of colic
are a few basic ways the newborn can be eased of initial difficulty and dysfunction.

Dentistry
CranioSacral Therapy enhances dental care by providing techniques that ensure a dental
patients craniosacral system remains balanced and that dysfunctions are not introduced
into the craniosacral system as a result of orthodontic appliances, which often restrict
maxillary movement(11). CranioSacral Therapy has a full range of techniques for the hard
palate; release and mobilization of teeth, which encourages their natural positioning; and
release of soft tissues in and around the oral cavity, including the hyoid.
Before dental work is performed, the craniosacral system can be balanced and any tension
in the gums and teeth released, ensuring dental or orthodontic work is placed upon
previously balanced structures. Then, after dental or orthodontic work is complete,
especially following the removal of appliances, CranioSacral Therapy can be utilized to
restore balance to the patients mouth, hard palate, temporomandibular joints, and cervical
soft tissues.
Acupuncture
CranioSacral Therapy has had a longstanding integration with acupuncture. Both practices
are mutually supportive, specifically: acupuncture assists the CranioSacral Therapist by
providing pain control, and CranioSacral Therapy assists the acupuncturist by providing
their clients with the experience of deeply integrated relaxation techniques, soft tissue
release over acupuncture points, and meridian unwinding, which increases the overall flow
of Qi within the body.
Other Categories of Care
There are many clinical applications for CranioSacral Therapy. In addition to the categories
elaborated on above, I would like to mention a few more including, chiropractic(12),
therapeutic massage and bodywork, ophthalmology, otology, sports medicine, hospice,
elder care, addiction recovery, and veterinary medicine.
General Clinical Indications
Below is a selection of indications representing common clinical situations in which
CranioSacral Therapy has been shown effective. Note: acute conditions require medical
care, and physicians should be consulted if there is any doubt about treatment. Referral to
an advanced CranioSacral Therapist is also recommended in cases of doubt or risk.

Acquired Immune Deficiency Syndrome (AIDS)

Alzheimers disease

Anxiety and panic attacks

Appendectomy

Arachnoiditis

Arthritis, Rheumatoid Arthritis (RA), Osteoarthritis (OA)

Asthma

Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder

(ADHD)

Autism Spectrum Disorder (ASD) including Asberger Syndrome

Bells Palsy

Blackouts and fainting spells

Breast cancer (post mastectomy)

Bruxism

Cancer

Carpal Tunnel Syndrome

Cauda Equina Syndrome

Cerebral Palsy

Cesarean birth

Childbirth

Chronic Fatigue Syndrome (CFS)

Chronic infections

Coccygeal pain

Compressed vertebrae

Cranial bone and meningeal membrane lesions

Degenerative brain disease (Alzheimers, Parkinsons, and senile dementia)

Depression (and endogenous idiopathic depression)

Digestive issues and bloating

Dyslexia (can be of occulomotor or nervous etiology)

Dysmenorrhea

Earache

Edema

Emphysema

Endometriosis

Fibroids

Fibromyalgia

Forceps birth

Headaches (and migraines)

Head injury

Heart disease (HBP, and atrial fibrillation)

Herniated vertebral discs

Hip replacement surgery

Hysterectomy

Gastroesophageal Reflux Disease (GERD, acid reflux, heartburn)

Infant colic and feeding problems

Kyphosis

Limb length differences

Lordosis

Lymphatic stagnation

Memory loss

Menstrual cramps

Neck pain

Nerve Entrapment (including sciatica) and irritation (including carpal tunnel

syndrome)

Neuralgia

Neuresthesia (including paresthesia such as in TOS)

Occlusion (bite) issues

Osteoporosis

Ovarian cysts

Paralysis

Parkinsons disease

Post surgical recovery

Post Traumatic Stress Disorder

Pregnancy (can be used in all phases)

Prostate problems and repairs

Rotator cuff injury (and other shoulder and arm soft tissue dysfunction)

Sacral concussion

Sciatica

Seatbelt injury

Seizures

Seizures

Sleep disorders (including apnea and insomnia)

Spasticity

Speech problems

Spinal stenosis

Spondylolisthesis

Spondylosis

Strabismus

Strains and sprains and dislocations (recovery)

Stress

Stroke (post-stroke syndromes)

Subluxations (can be used by a chiropractor to normalize soft tissue)

Sympathetic nervous system hypertonus (reticular alarm system)

Temporomandibular joint dysfunction (TMJD)

Tendonitis

Tenosynovitis

Thoracic Outlet Syndrome (TOS)

Thyroid problems

Tinnitus

Torticollis (and cervical muscle dysfunction)

Trauma and traumatic stress

Tumors

Urogential issues

Vacuum extraction birth

Vertigo

Vertebral fusion or vertebral implantation surgery

Whiplash injury

Contraindications for CranioSacral Therapy

CranioSacral Therapy has few contraindications. However, these must be observed:

Recent brain hemorrhage, stroke, cerebral aneurism, or brain injury or tumor

(Obtain permission of the clients physician. They should verify there is no
more bleeding, and its safe to go ahead)
Recent spinal tap. (Obtain permission of the clients physician. They should
verify there is no more leaking of cerebrospinal fluid)

Arnold Chiari Malformation - incomplete foramen magnum. (Obtain permission

of the clients physician. Use the lightest pressure possible, and place no inferior
strain on the dural tube. Avoid OCB, inferior traction)

Downs Syndrome, Rheumatoid Arthritis (Any situation where ligaments and soft
tissues are compromised should be treated with extreme care, and no OCB platform
should be undertaken)

Footnotes
1 Upledger, DO, OMM., John. Addressing the Skeptics, Part II. Massage Today, Vol. 4,
Issue 2 at: http://www.massagetoday.com/mpacms/mt/article.php?id=10877

2 Upledger, DO, OMM., John. CranioSacral Therapy: Who Shall Do It?. Massage Today,
Vol. 4, Issue 5 at: http://www.massagetoday.com/mpacms/mt/article.php?id=10925
3 Towards the Prolongation of a Healthy Life Span, New York Academy of Science Annals,
Volume 854. Cited: http://www.massagetoday.com/mpacms/mt/article.php?id=10426 and
http://www.massagetoday.com/mpacms/mt/article.php?id=10962
4 It should be noted that Allopathy has cures for only 10% of known diseases. In the
clinical experience of many CranioSacral Therapists and their clients, it has been shown
that CranioSacral Therapy resolves the underlying causes of dysfunction more than 10% of
the time.
5 See: Atlas of Functional Neuroanatomy. Hendelman, Walter. CRC Press, 2006.
6 Upledger, DO, OMM, John. CranioSacral Therapy Alters Brain Functioning: A Clinical
Overview. Massage Today, Vol. 03, Num. 12. at:
http://www.massagetoday.com/mpacms/mt/article.php?id=10837.
7 Austin, James H. Zen-Brain Reflections. MIT Press. 2006. Page 52.
8 Atlas of Functional Neuroanatomy. Hendelman, Walter. CRC Press, 2006. Page 116.
9 http://en.wikipedia.org/wiki/Cortisol and
http://ptsd.about.com/od/ptsdandyourhealth/a/breastcancer.htm
10 http://en.wikipedia.org/wiki/Cortisol
11 Upledger, DO, OMM., John. TMJ: Primary Problem, or Tip of the Iceberg? Massage
Today, Vol. 2, Num. 8. At:
http://www.massagetoday.com/mpacms/mt/article.php?id=10531
See: Upledger, D.C., Lisa. CranioSacral Therapy Releases Hold on Subluxations. Vol. 27.
Num. 13. At: http://www.theamericanchiropractor.com/articledetail.asp?
articleid=492&category=3