001. what is craniosacral therapy?
What is Craniosacral Therapy?
What craniosacral therapy is depends on who you ask. It is my opinion that we can’t understand it through western science alone, and my belief is supported through the historical context and lineage of how this work came into being. I would like to first share what I have learned about the context of this work before I share what I think that it means, because, spoiler alert- there is so much that lives here that is not up to me.
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There are different schools that teach and explain craniosacral therapy, the cranial rhythm, and the craniosacral system in different ways. There is also plenty of controversy surrounding this modality, and many questions surrounding its effectiveness and legitimacy.
It is listed as pseudo-science on wikipedia, and in the words of some random person I just found on reddit: “Chiropractors are synonymous with fortune tellers”. Craniosacral therapy is a branch of osteopathic medicine, just like chiropractic care is, so this is still relevant in describing common perceptions of craniosacral therapy.
From my understanding, much of this controversy in the medical world revolves around a hot button debate regarding the potential for movement in-between cranial sutures. Craniosacral therapists could not do what we claim to do if the cranial sutures completely fuse in early adulthood. On top of challenging what many already consider a fact of life re: cranial sutures fusing, some of the tools in a craniosacral therapist's toolbox are energetic in nature. This brings its own kind of air of uncertainty and accusations of “quackery” to the science obsessed.
Many of the core concerns around the legitimacy of craniosacral therapy from a scientific perspective have been effectively challenged and disproven in laboratory settings, thanks to the work of John Upledger and his colleagues. Understanding the functions of the craniosacral system and creating a protocol for working with it to promote ease, flow, and presence was Dr. Upledger’s life’s work. The point of this writing is not to share his findings, or to prove that this work means something. The point is to explore why we are still asking this question through a seldom represented perspective. This perspective is one that credits Indigenous Americans for the “discovery” and naming of osteopathic medicine.
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The discovery and naming of osteopathic medicine, as it exists here on Turtle Island (the Indigenous naming of this land mass we call America), is an intimate dance with settler colonialism and cultural genocide.
To put it plainly, in Susan Raffo’s words: “craniosacral therapy would not exist without Andrew Taylor Still’s relationships with Cherokee and Shawnee healers.” And as further confirmed by Nita Renfrew, “Dr. Mehl-Madrona, who is seeking to honor and preserve Cherokee Bodywork, came to this conclusion after experiencing and seeing the many similarities between Cherokee Bodywork and Osteopathy”.
Andrew Taylor Still M.D. is credited as being the founder of osteopathic medicine. In 1892 he went on to open the Kirksville School of Osteopathic Medicine. For the purposes of this writing, he is the first in a line of 3 men that are most commonly referenced when talking about the discovery of the craniosacral system, and the therapeutic ways in which we interact with that physiological system.
Still’s main therapeutic concepts were, as identified by Dr. Upledger are:
The body functions as a dynamic unit
Structure and function are interrelated
The body has a self-regulating system which bends towards homeostasis
Drugs may be harmful
Susan Raffo’s article “Aligning the relational field: a love story about retelling the creation of craniosacral therapy” provides ample context on Still’s life, including the fact that he himself was very likely of mixed Native and settler ancestry. We know, for certain, that he lived/studied/worked among the Shawnee. Most of what is spoken about here is simply reiterated from Raffo’s article and the references she has generously provided to us all.
The second man in this line of 3 is William Sutherland D.O., who is often referred to as the father of cranial osteopathy. Sutherland was considered one of Still’s most brilliant students. He extensively studied cranial sutures, and through self experimentation he found that they do indeed allow movement. Sutherland also saw the movements of the sacrum and occiput (2 crucial touchpoints for craniosacral therapists) as being connected.
The third man is John Upledger. Upledger named craniosacral therapy, and went on to teach the protocol he developed for working with the craniosacral system through the Upledger Institute.
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Thanks to the work of Dr. Mehl-Madrona, we know that Cherokee bodyworkers “are masters at working with energy and the breath, and they also move cranial bones, seeking the ridges, albeit with more force than Craniosacral practitioners. They do this along with osteopathic-like massage and manipulation of musculoskeletal tissues, organs, and joints, as well as acupressure on points and energy channels (that, in fact, correspond to the meridians). They combine all this with gentle rocking and with narrative healing, both verbal and energetic, using storytelling, and dialogue with the musculoskeletal system and with the client, and intense breathwork to “restore spirit” to all parts of the body, when giving treatments that they commonly refer to as “doctoring”.”
All things considered- for me, the controversy surrounding the value of craniosacral therapy lies within the schism of cultural theft and disappearance, and the dualistic wound of having your work devalued, criminalized, and yet still regarded as profound enough to repackage and sell without credit where it is due. In Andrew Still’s time, the work he was introduced to through his family’s relationship with the Shawnee was considered “devil worship” by Christian missionaries.
As a biracial person of both settler and native descent, Still’s motivations for concealing the nature of “his” work as he went on to teach remain unknown. What we do know is that Still only ever alluded to his relationship with Shawnee healers through describing himself as “taking an Indian look” at something.
Many of the root ties to this vital work have been lost because of the narrative of “savagery” imposed upon Indigenous peoples and traditional lifeways, and the demonizations of such.
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I hope that this brief introduction can shed some light on the origins of this profound work. I don’t have anything intelligent to add to this conversation from any research of my own, just words to uplift from others. I defer to the indigenous medicine carriers and preservers, and highly encourage you to read the articles listed below.
That being said, in an effort to be in the right relationship to this work, I am keeping my eyes, ears, and heart open to further uncoverings. It is my belief that this type of work has many names in many places (I can thank Susan Raffo for planting this seed in my brain as well), and I am personally invested in seeking out where there may be links to profound hands-on modalities/medicine as it is connected to my own ancestry. This will be a life-long process that can‘t be rushed.
At this time, I am donating 10% of CST session proceeds to The National Native American Boarding School Healing Coalition. This feels like a tangible way to support those directly impacted by colonial narratives that have reduced Indigenous medicine and lifeways to “devil worship”. If you are unfamiliar with boarding schools and the trauma and death they inflicted upon those Indigenous to so called North America, please read this.
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Please read the following for more context from people that have done the work:
Traditional American Indian Bodywork, the Origin of Osteopathy, Polarity, and Craniosacral Therapy by Nita M. Renfrew
American Indian Bodywork: The Origin of Osteopathy by Dr. Shawn Pourgul
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What do I believe that Craniosacral therapy is?
I would like to start by mentioning that I - in no way, shape, or form, consider myself a practitioner of Indigenous body work. I have no reason to believe that I practice this medicine in the ways that it was originally intended to serve.
The reality is that what I know is the groundwater that remains after many lenses and perspectives have passed through. This includes distortions. I would like to add that in order to practice this medicine, I must distort the way that it has been taught to me as well. This is in part because the people who have taught it to me have failed to acknowledge the roots of what we now know, and also because of who I am as a person and the way I wield my own power as a facilitator of healing space. The protocols and anatomy that I have been taught through the Upledger Institute tether me, but ultimately I veer towards the energetic parts of this practice.
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I was drawn to craniosacral therapy because I saw it as a powerful container for rest and release. From my perspective, it is a tool that does not concern itself with linear time, and therefore is a great tool for issues that may have been inherited through ancestral (or otherwise) channels (epigenetics, or karma if that’s your cup of tea). I found this tool in a time where I felt absolutely drained and perpetually haunted by all that led me to this lifetime.
Craniosacral therapy is an incredible tool for treating or addressing injuries that may have happened decades previously. These old wounds of ours may have healed, technically speaking, but oftentimes we are stuck dealing with compensation patterns and weak spots for much longer than we are told to anticipate. Everything changes everything. This speaks to emotional injury and trauma as much as it does whiplash from a car accident.
I believe that, in the way Ariana Felix (The Dream Mami) once said, sometimes the only Justice available to us lies within moments of nervous system regulation. We live in a shared reality that holds enough horror beyond comprehension. I believe that justice, wherever and however we can find it, is a necessary pursuit.
It is also my belief that when we can afford to, we should start with ourselves. A la “be the change you want to see in the world”. I think that craniosacral therapy is a profound worldbuilding tool because it affords us opportunities to release what may be in the way of embodying the new pathway forward.
This can be ugly work. This can be plutonic excavation work. This work can feel like an exorcism, or it can look like a nap on the table. What your body needs in order for rest and release to be possible is not up to me, and is not something that either of us can anticipate leading up to treatment time.
As your therapist, I believe that it is my job to hold a compassionate space to witness and respond to the body of my client, without assumptions. While intake for Craniosacral sessions is still important, what I am responding to is based on what my hands are sensing at the given moment. The things that I do during treatment are not based on some calculation predetermined by a mixture of symptoms. This is…… irrefutable, and so incredibly exciting and important to me for so many reasons.
Because of the craniosacral system’s relationship to the nervous system, we have the profound opportunity to induce deep states of rest & digestion (in windows of parasympathetic dominance) using craniosacral therapy as a tool. By releasing restrictions in the fascia, facilitating decompression of joints, or encouraging healthy blood circulation and unrestricted flow of cerebrospinal fluid at key touch points within the craniosacral system, we are also freeing the central nervous system to operate at its natural best. Of course, what that looks like for each of us varies greatly.
This treatment can naturally address chronic pains and stress, and strengthen our bodies inherent abilities to protect and nourish itself. Not only does this help to address currently present stressors, craniosacral therapy can also deepen our bodies ability to adapt and remain flexible when we respond to future stressors and challenges.
As my Upledger based mentor-friend Rebecca Decoster (A Focused Touch, Rebecca is a practitioner of Craniosacral Therapy, Visceral Manipulation, and Equine Bodywork) reminded me during our last session together, the treatment itself stretches far past our time on the table.
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What can I expect during a treatment?
A session typically takes place with the client fully clothed, lying face up on a massage table. Craniosacral therapy is a light touch therapy that clients typically find comforting, gentle, and relaxing. My goal as a craniosacral therapist is to affect therapeutic change with as little pressure as possible.
While on the table, you can typically expect to feel changes in your body temperature, wandering sensations, phantom tingles or aches at old sites of injury. It is not uncommon to re-experience thoughts or memories that are attached to certain areas of the body as they are lit up. I understand that for some of us, this might be more uncomfortable or triggering than for others. The emotional content of what might come up during a session is damn near impossible to predict, but I do promise to respond to you with compassion and steadiness.
A session begins with your therapist assessing the body for the cranial rhythm, which can be felt anywhere on the body. It is typically felt as a rhythmic expansion & contraction. The cranial rhythm is best described as how your body's fascia is responding to the rise, fall, and circulation of cerebrospinal fluid throughout the craniosacral system.
After assessing for restrictions, we move on to treatment. First we facilitate release and decompression at key points around the craniosacral system, then we move on to considering the entire body. I am continually assessing for areas of blocked energy/movement and then treating them with a myriad of tools.
It is common for people to feel a bit taller when they get off the table. Many feel more ease in their posture, an increase in range of motion, and also a general feeling of lightness.
After a treatment, you may feel a little dizzy. You might feel deep in rest mode and ready for a nap. Getting off of the table slowly and planning a light day following your treatment is recommended.
I would like to stress that: while the application of craniosacral therapy itself is gentle, the nature of what the body is willing to process and/or let go of at the time of your session may not always be light material. It isn’t uncommon for emotional states of imbalance or correlated intrusive thoughts/images to resurface while addressing physical sites of injury. This means that for some, additional processing/treatment will be required depending on the nature of what surfaces. At times, I may have to refer out for things that are over my head.
Sessions will often include a varying degree of conversation between the client and therapist. I have found that sometimes asking my client to speak about what they are experiencing on the table, while I remain a neutral observer, is what helps to facilitate release. You are not by any means expected to be vulnerable with me in this way, but please know that you are invited to share what feels right for you.
Craniosacral therapy uses a variety of tools to achieve release and encourage the body towards a homeostatic environment that begets self-correction. Herein lies a major difference between massage and craniosacral therapy. Craniosacral therapy is often called massage, and this irks me.
One last thing to consider- some people learn craniosacral therapy in 4 hours, and some people dedicate their entire careers to diving deeper into this modality. I don’t bring this up to be judgemental, but you should be prepared in knowing that if you have received craniosacral therapy from a massage therapist that took a 4 hour long online course, you should in no way expect to have a similar experience working with me.
What does release mean?
One of the big things I rely on when deciding if my work with a particular area of the body is done or not is monitoring for signs of release.
Release can look like- feeling a part of your body drop down into my hand.
It can be a change in body temperature. A deep sigh, fart, burp, or involuntary muscle twitches.
It might be a stream of tears released for something from another time as you feel your shoulders drop and your chest open. It might be when the feeling in my hand shifts from a tight chaotic loop into gentle waves.
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In the last section of this document, we will dig into some of the nuts and bolts of craniosacral therapy as I have been taught it. ~science~
This part of the document has been filled out using my notes from live classes, Upledger Institute provided study guides, and notes from recommended reading materials as per course protocol. No copyright infringement intended. The following information is for educational purposes only.
Hard contraindications: if is not safe to receive craniosacral therapy if you experience any of the following
Increased cranial pressure
Acute stroke
Cerebral aneurysm
Hemorrhage
Herniated medulla oblongata
Recent skull fracture or concussion
Cerebrospinal fluid leak
Spina bifida
Arnold Chiari malformation
Any other condition or injury where a change in intracranial/intraspinal fluid pressure may be unsafe
Blood clots
Cautions: the following may require a more advanced practitioner or specialist
Any structural issues or recent injuries that may interfere
Pediatric care
Connective tissue disorders
Severe emotional trauma or active addiction
Indications for care: craniosacral therapy may benefit if you have experience any of the following
Chronic pain
Chronic stress
Depression, anxiety
Chronic headaches or migraines
TMJ pain
Pain or whiplash following car accidents
Difficulties concentrating or with memory
Long COVID, brain fog
Much much more
What is the role of the craniosacral system within the body?
The craniosacral system is most often described as a semi-closed hydraulic system. It is housed inside the Dura Mater (a tough waterproof membrane) that holds the brain, spinal cord, and spinal fluid. This means that the craniosacral system provides the environment in which your brain and nervous system develop and function throughout the course of your lifetime. This truth struck me even deeper when I learned that it is the amniotic fluid that becomes our cerebrospinal fluid (much gratitude for the vibrant and inspired teachings of Bonnie Bainbridge Cohen, who was once a student of Dr. Upledger).
The craniosacral system is a functioning physiological system, not an energetic one. It consists of cerebrospinal fluid (CSF), the membranes that contain it, its bony attachments, and the mechanisms that produce and reabsorb CSF.
“This fluid (*CSF*) transports nutrients, hormones and peptides. It removes metabolic waste and toxic substances. It serves as a shock absorber, floating the brain to counteract gravity. It even influences respiration and cerebral blood flow, among its many functions.
Given all this, it's easy to see how essential it is for CSF to flow unimpaired. If an area of brain tissue is even partially deprived of optimal CSF motion and flow, that area will be forced into some degree of functional compromise.”
John Rollinson, D. Eu, CST-D
The Pressurestat Model Explains the Craniosacral Rhythm
The craniosacral system is intimately related to / influences / is influenced by the nervous system, the musculoskeletal system, the vascular system, the lymphatic system, the endocrine system, and the respiratory system.
All theories on how the craniosacral system circulates cerebrospinal fluid are still theories. The Upledger Institute posits the theory of a “pressurestat model” in which the craniosacral system is a semi-closed hydraulic system.
Also in the words of Rollinson, this is how the pressurestat model functions:
“We have a hydraulic system that surrounds the brain and spinal cord. To understand how it is semi-closed, we must first understand how CSF enters and leaves the system. Within the ventricles of the brain, you'll find a capillary network - the choroid plexus - that produces CSF. In essence, blood circulating through the choroid plexus is "turned into" CSF, which then enters the craniosacral system.
The choroid plexus has stretch- and compression-sensing receptors within the sagittal suture of the cranium. As CSF is added to the craniosacral system and its volume increases, the dural container expands, spreading the bones of the head. The parietal bones then move apart and spread the sagittal suture. When this happens, the whole neuromechanism signals the choroid plexus to stop or greatly reduce the production of CSF. As the fluid drains from the system, the dura and cranium shrink and the parietals come together, compressing the sagittal suture. The pressure-sensing nerve endings connected to the choroid plexus then send a signal to resume CSF production and the cycle repeats.”
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“CranioSacral Therapy helps address both the biomechanical framework that may cause distress, and the neurological patterns that may have formed in relationship to that distress. If connective tissue stressors are addressed, yet the associated neurological patterns are not, then only part of the overall pattern has been treated. Addressing the entire strain pattern by integrating correction within both the connective tissue matrix and neurological system through the delicate touch of CranioSacral Therapy can help improve health and healing in an efficient and comprehensive way.“
Tad Wanveer, L.M.B.T., C.S.T.-D.
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Further reading material:
Upledger Institute- CranioSacral Therapy Research
Upledger Institute- An Introduction to the Upledger Craniosacral Therapy Paradigm
Craniosacral Therapy.... What is it Really? By Mariann Sisco PT, CST-D
Upledger Institute- SomatoEmotional Release
How Craniosacral Therapy May Contribute to Brain Health, by Tad Wanveer LMBT, CST-D
Upledger Institute- Neutrality in Upledger Craniosacral Therapy
