Cranio-sacral therapy

The entire dural system is formed by a continuous, pain-sensitive membrane that starts covering the inner cranium and exiting the foramen magnum forming the spinal dura. The intracranial dural folds (e.g., falx and tentorial cerebelli) conduct the dural venous sinuses. The dura is a very sensitive and painful fascial structure, and is kept in place surrounding the brain and the spinal cord at the following points:

(a) Inner skull vault (At the crista galli anteriorly, and sphenoid & petrous bones medially)

(b) Foramen magnum (Posterior attachment)

(c) 2nd & 3rd cervical vertebrae

(d) Posterior longitudinal ligament via the meningovertebral (Hoffman’s) ligaments

(e) 2nd sacral body

(f) 1st coccygeal vertebrae (Film terminalis)

The distal dural attachment, the film terminalis, attaches to the periosteum of the 1st coccygeal vertebra. The coccyx and the sacrum moves during inspiration and expiration normally in the sagittal plane along the motion of the “Sphenoid bone” in the skull, a movement known as the “Cranio-sacral pump”. This craniosacral pump is important for the motion of the cerebrospinal fluid. Dysfunction of the sacro-coccygeal movement will affect the “Piriformis muscle”, an important sacrum stabilizer (Pericardium meridian)

In osteopathy and chiropractic teachings, “Craniosacral therapy” states that failure of the cranio-sacral cerebro-spinal fluid (CSF) pump results in stagnation of the CSF, which will result in structural abnormalities. Stagnation of the CSF occurs mainly at 4 main body diaphragms, which are:

1. The base of the skull dura (Cvertebra)

2. The thoracic inlet (Cvertebra)

3. The muscular diaphragm (T11 vertebra)

4. The pelvic diaphragm (Lvertebra)

Dural tension is a pathological condition where the dura matter is being pulled under pressure causing either pain due to its rich sensory supply, or spinal cord misconfiguration (Via the dentate ligament attachment), leading to spinal cord injury as a consequence of spinal arterial compression and ischemia. Dural tension is typically caused by: vertebral malalignment, acute disc herniation (Lumbago), sphenoid bone asymmetry, and sacrococcygeal joint dislocation (Film terminalis tension)

Dural tension at any dural attachment point is capable of generating symptoms due to the pain-sensitive nature of the dura matter; for example, an occipito-atlanto-axial sublaxation can create a cervical dural tension that radiates to the sacral region causing sciatica-like pain (Sciatica brachialis), while a sacroiliac instability can create a dural tension that radiate upward to the craniocervical region generating “Suboccipital headache

The ventral dura matter is supplied by sensory (Nociceptivenerve plexus that is derived from the “Sinuvertebral nerve” and the “Nerve plexus of the posterior longitudinal ligament”. The sinuvertebral nerve originates exclusively in the rami communicantes and has a “Sympathetic nervous system” component. Therefore, dural tension can result in “Sympathetic hyperstimulation” (Dysautonomia)

Lastly, the dura matter in the posterior suboccipital region is attached to the “Rectus capitis posterior minor (RCPM) muscle” by a fibrous band / bridge, known as the “Myodural fibrous bridge”. In cases of cervical vertebral sublaxation, myofascial trigger point develops within the RCPM muscle, which will exert traction force on the pain-sensitive dura causing dural inflammatory thickening and suboccipital pain (Suboccipital headache)

The bowling ball syndrome

In his book, “Healing is Voltage”, Dr. Jerry Tennant describes the term “Bowling ball syndrome” first used by Robert Boyd (DO), from Ireland, who stated that the sphenoid bone is the center of gravity for the head, which he described it as a bowling ball in terms of its heaviness. Boyed has described a cranio-sacral therapeutic technique for correcting sphenoid bone malaligment. The same concept of sphenoid bone malalignment, cranio-sacral pump, and craniosacral therapy have been described also by other investigators like: Andrew Taylor Still (MD), William G. Sutherland (DO), and John Upledger (DO)

Boyed’s cranio-sacral therapeutic technique was based on manipulating the trapezius muscle, which will pull the occipital cranial bones to re-align the sphenoid bone, since the occipital bones are attached to the sphenoid bone. Dr. Jerry Tennant also mentioned in his book that Revenko, from Russia, described a technique to correct the sphenoid bone malalignment via the trapezius muscle contraction similar to Boyed’s manual technique by using a bioenergetic device called the “Little Wings

Dr. Jerry Tennant describes a similar technique by using his device, the “Biomodulator™”, in which a microcurrent pulses are sent through the sternocleidomastoid muscle to stimulate the “Accessory nerve”, the 11th cranial nerve, which supply both the trapezius and sternocleidomastoid muscles. By stimulating the accessory nerve, the trapezius muscle will contract and the brain will re-adjust the position of the muscle bilaterally, re-aligning the occipital bones in such a movement and subsequently, the sphenoid bone


Selected references

1. Eriksen K. Upper Cervical subluxation complex: a review of the chiropractic and medical literature. 2003; Lippincott William & Wilkins; 1 edition

2. Tennant J. Healing is voltage; the handbook. 2010; CreateSpace Independent Publishing Platform; 3rd edition

3. Walther DS. Applied kinesiolgy synopsis. 1988; Triad of Health Publishing; 2nd edition

4. Upledger JE et al. Craniosacral therapy. 1983; Eastland Press; 1st edition

5. De Andrés J et al. Coccygodynia: A Proposal for an Algorithm for Treatment. The Journal of Pain 2003; 4(5): 257-266

6. Woon JTK et al. Clinical Anatomy of the Coccyx: A Systematic Review. Clinical Anatomy 2012; 25:158–167

7. Lynn S et al. Radiographic evidence of cranial bone mobility. The Journal of Craniomandibular Practice 2002; 20(1): 34

8. Grassi R et al. Coccygeal movement: Assessment with dynamic MRI. European Journal of Radiology 2007; 61: 473–479

9. Patel N et al. Anatomy and Imaging of the Normal Meninges. Semin Ultrasound CT MRI 2009; 30:559-564

10. Mouhsine E et al. Posttraumatic coccygeal instability. The Spine Journal 2006; 6: 544–549