Craniosacral Osteopathy

Hossein Khorrami, Ph.D. DOMP

 Osteopathic Principles
• The body is a unit, and the person represents a
combination of body, mind and spirit
• The body is capable of self-regulation, self-
healing and health maintenance
• Structure and function are reciprocally
interrelated
• Rational treatment is based on an understanding
of these principles: body unity, self-regulation,
and the interrelationship of structure and
function
 Osteopathic Principles

• Andrew Taylor Still:

– Normal movement of the body’s structure is
essential to their function and to effective
homeostasis
 Dysfunction in Osteopathy
• When the normal movement of an organ
hindered
• Could be symptomatic
• Modifications or mitigated by the organism
 Dysfunction
• Primary dysfunction
• Secondary modification or a new
dysfunction(sometimes)
• …..
• Restriction in movement
• Adaptation
• Characteristics like morphology, genetics,
activities, life style, habits and… are important
• Asymptomatic
• Or a complex dysfunctional network
 Complex dysfunctional network
• If permanent and reaches vital structures:
– Reduce adaptation ability
– e.g. diaphragm, liver, intestine…
– Fatigue, constipation, diarrhea, insomnia, mood
disorder… as symptoms
 Craniosacral
• It was an American osteopath in the early
1900's, William Garner Sutherland, who made
a study of the cranial bones and he realized
that the sutures were designed to allow for a
specific movement pattern of the cranial
bones
• The brain is surrounded by a fluid, the
cerebrospinal fluid (CSF), which also surrounds
the spinal cord
• The CSF is enclosed within a membrane
system, the dural membranes, or meninges,
which together form a hydraulic system
• The dural membranes give attachment to the
cranial bones and the sacrum, which together
with the spine, offer protection to the brain
and spinal cord
• Our brain and spinal cord, our central nervous
system (CNS), is essentially floating inside our
head and spine
 Glial cells
• 10 times than neurons
• 50% of volume • O2A, in remyelination
• Astrocytes in BBB • Microglia as
macrophage

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Glymphatic System

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 Astrocytes
• Ions & NT regulation in ECF
• Buffering K+
• Beta amyloid protein removal
• Trophic support of neurons, nourish
• Boundaries between adjacent
process(insulate)
• Capillaries & neurons
• Forming glial scar
• Removing debris
• Neurotaxism
• CSF flow
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• If the cellular system became overloaded or
slowed down as we aged, metabolic garbage
would build up between the cells
• This garbage includes products such as beta-
amyloid, the protein associated with
Alzheimer's disease

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 The meninges: three membranes
envelop the entire CNS
(central nervous system)
dura mater The outer, hardest, toughest

arachnoid The middle, web like

pia mater The inner, thinner

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 Maninges
• Dura mater
– Attachments: occip. Sagital, frontal, Crista Galli of
ethmoid, sella tursica of sphenoid, C2-3, S2-3
• Arachnoid
• Subarachnoid
• Pia mater
Spaces between the meninges

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 Meninges
• Dura mater
– Outer layer
• Fibrous connective tissue, covering inner aspect of
cranial bones, extend to sutures and outer surface
– Innermost layer
• Falx cerebri
• Tentorium cerebelli
– Sinuses between them
• Arachnoid
• Pia mater
Dura Matter & Dural Sinuses
 Reciprocal Tension Membrane(RTM)
• Dural membranes are under constant tension
• Movement of brain & CSF transmit to
membranes as a dynamic shifting of the
reciprocal tension
 CSF
• Clear body fluid, produced by plexus choroid
• Nearly protein-free fluid
• Daily production: 500-600 ml
• Total: 100- 160 ml

• https://www.youtube.com/watch?v=JCf273U0ktc

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 Cerebrospinal fluid
• Cerebrospinal fluid: watery liquid
is found inside the brain, spinal cord, and
subarachnoid space
supports the brain’s weight
protects and cushions the brain and the spinal
cord

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CSF

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 CSF vs Plasma
Substance CSF Plasma
Water Content (%) 99 93
Protein (mg/dL) 35 7000
Glucose (mg/dL) 60 90
Osmolarity (mOsm/L) 295 295
Sodium (mEq/L) 138 138
Potassium (mEq/L) 2.8 4.5
Calcium (mEq/L) 2.1 4.8
Magnesium (mEq/L) 0.3 1.7
Chloride (mEq/L) 119 102
pH 7.33 7.41

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 Increased intracranial pressure
• Behavior changes
• Decreased consciousness
• Headache
• Lethargy
• Neurological symptoms, including weakness,
numbness, eye movement problems, and double
vision
• Seizures
• Vomiting
• https://www.youtube.com/watch?v=kaOphkMv2pM

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 CSF
• Choroid plexus
• Ventricles I-IV

• Foramen of Magendie

https://www.youtube.com/watch?v=Gqw4vd8qApQ
Ventricles
CSF & BBB
Flow of CSF
 CSF
• CSF; production: 650ml/day- total vol:
125ml/ circulation/composition: isosmotic;
low protein & glucose, hi Na & Cl,
• O2 consumption at rest: 49 ml/min (20% of
total)
• Blood flow at rest: 798 ml/min (15% of total)

• Glucose consumption at rest: 77 mg/min

• the CSF is able to circulate around the brain
and up and down the inside of the spine
• The pulsation is called "THE CRANIAL
RHYTHM", the movement pattern of the skull,
dural membranes and CNS is known as
"CRANIOSACRAL MOTION”
• Not only the skull and CNS, but all body
tissues exhibit cranio-sacral motion
 CSF Absorption
• Dura 95%
• Lymphatic system 5%
 Dural Attachments
• Cranial vault, crista galli, sella turcica
• Laterally, the two temporal bones
• Foramen magnum to C2-C3
• Anterior portion of sacral canal, S2 (S3)
• Periosteum of coccyx
 Important Sutures
1. Coronal Suture – between frontal & Parietal bones
Very few adult cases with frontal/ Metopic Suture
2. Sagittal Suture (Parietal Suture) between the 2 Parietal Bones
a. Parietomastoid Suture
b. Sphenoparietal Suture
3. Sphenofrontal Suture
a. Spheno parietal suture
b. Spheno squamosal suture
c. Spheno zygomatic suture
4. Squamosal Suture
a. Sphenosquamosal Suture
b. Zygomatic temporal Suture
5. Lambdoidal Suture
a. Occipitomastoid Suture
 • The metopic suture (also known as the
median frontal suture) is a type of calvarial
suture
• It is often associated with frontal sinus
agenesis or hypoplasia

https://www.youtube.com/watch?v=FrpVzSK23Q0
 Temporal Bone
• Mastoid part
• Squamous part
• Tympanic part
• Zygomatic part
• Styloid process ( anchor for muscles and ligaments)
– stylohyoid ligament
– stylomandibular ligament
– styloglossus muscle
– stylohyoid muscle
– stylopharyngeus muscle
 Temporal bone
• The temporal bone articulates with five skull
bones:
• Occiput
• Parietals
• Sphenoid
• Zygomas
• Mandible
Pterion
 Pterion
• the region where the frontal, parietal, temporal, and
sphenoid bones join together
• The pterion is known as the weakest part of the skull
• The anterior division of the Middle Meningeal Artery
runs underneath the pterion
• Consequently, a traumatic blow to the pterion may
rupture the middle meningeal artery causing an
epidural hematoma
• The pterion may also be fractured indirectly by blows
to the top or back of the head that place sufficient
force on the skull to fracture the pterion
 Bevel angle
• Perpendicular
– Frontal-parietal
• Flat
– Temporal-parietal
 Sutherland model
• By Garner Sutherland
– Movement of cranial sutures, ---> craniosacral
concept
– Cranial Rhythmic Impulse(CRI)
• Is the motility* of the nervous system

*mobility is possibility of being moved

*motility is move by itself
• The CNS has been found to expand and
contract in a rhythmic motion, to pulsate, at
the rate of about 6-12 times per minute, or
should do so in health
• To allow for this normal, pulsing movement,
the dural membranes must be free and
flexible and the cranial bones need to move in
a regular, coordinated pattern
 Receptors
(eyes, ears, other sense organs)
change information from outside the
body ( for example, light waves) into
electrical impulses.
Digitalization

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Receptive field

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Stimulus Receptor Location Receptive Adaptation
field
mechanoreception
Touch, pressure Free nerve ending Hair root Variable

Small
Texture, steady Merkel receptor Slow
pressure Superficial
Flutter, stroking Meissner Rapid
Stretch Ruffini Deep Large Slow
Vibration Pacinian corpuscle Extremely rapid
Thermoreception
Cold Free nerve ending Superficial Small Rapid
Warm
Nociception
Thermal Small Rapid
Free nerve ending Superficial
Mechanical Large Slow
Polymodal ( chemical) Large Slow
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 Theory
• Balancing CSF circulation and pressure by way
of releasing the reciprocal tension membrane
of the Meningeal System or the Dural tube
• Cranial Sacral Therapy utilizes the cranial
bones and the sacrum as levers on the Dural
tube in a manner that through traction 'folds'
or ‘rifts’ on the meningeal membrane are
stretched and re-aligned
Dural attachments
Reciprocal Tension Membranes
 Flexion and Extension
• Flexion is the normal motility movement
– Induces a swelling sensation
• Extension
SBS
 Flexion

• The occipital bone makes a backward rotation,

and the sphenoidal bone makes a forward
rotation, in which the SBS rises
• The occipital bone slides forward over the atlas
• This corresponds to a mechanical extension of
the occiput
• The ethmoidal bone, lying in front of the
sphenoidal bone, makes the same rotation as the
occipital bone
• The paired or peripheral bones make an external
rotation during flexion
• The forward movement of the occipital bone
and upward
• movement of the basilar part shift the
foramen magnum forward
• This results in a cranial pull on the spinal dura
mater
• Consequently, the base of the sacrum pulled
upward
• Causes sacrum extension & spine stretch
 Primary Respiratory Mechanism(PRM)

• Fluctuation of CSF
• Articular mobility of the cranial bones
• Involuntary motion of sacrum
• Inherent mobility of brain & Sp.cord
Flexion/Extension
Flexion & Extension
Cranial Flexion
 Malposition
• A sacral malposition affects the
Occipitoatlantoaxial (OAA) complex just as
much as a malposition in the temporal bone
or sphenoidal bone
• The consequences are even greater in the
spinal column because the sensitive muscle
spindles there have an exponential effect
 Venous Sinuses
• 1/3rd of blood in brain