So what is Craniosacral anyway? (part 1)

The word craniosacral can be a mouthful, most pronounce and articulate it very slowly to make sure they get all the five syllables. There is often a confused look in the eyes of those who ask me what I do, or they say, “So what is Craniosacral anyway?”. Most people connect the cranial portion as having something to do with the head, but sacral? Sacral refers to the large triangular bone in between the hips and at the bottom of the spine usually referred to as the sacrum. Often people get confused by the difference between the sacrum, coccyx, and tailbone. The coccyx is the much smaller triangular bone connected to the bottom of the sacrum. This is the bone injured when you slip on the stairs or catch an edge snowboarding. The coccyx is usually referred to as the tailbone. The cranial portion is the head, and the sacral portion is the sacrum including the tailbone.

The problem really isn’t solely with the name, it is simply that people haven’t heard the term frequently enough, although more and more people are becoming aware of it. Think about the word Chiropractic. No one really questions that, and it is a strange word if you think about it. People never say “what is a Chiro and what is a Practic?” They are Greek words that mean done by hands or practiced by hands. The Chiropractic definition describes what is being done. In that respect, the Craniosacral title describes what parts of the body are being focused on or treated.

Although the name implies the head and sacrum, Craniosacral is much more than that. Between the cranium and the sacrum is the entire spine and the spinal cord with its outer protective layer. You could say that Craniosacral implies the top and bottom of the spine or the two opposite poles of the spine. This means Craniosacral therapy treats the head, spine, sacrum, and the entire nervous system. The nervous system includes not only the brain, but also all the spinal nerves to hands and feet—this why Craniosacral is a full body therapy

Besides the arms and legs, the nervous system connects to all the organs. There are two branches of this system: the sympathetic and the parasympathetic. These two systems are constantly balancing all functions in the body like digestion, urination, blood flow etc. The cranial portion contains both systems, but the sacral portion is only parasympathetic oriented. Oversimplified, this is the calming/relaxing part of the nervous system: it balances the sympathetic parts that exit the spine. Craniosacral Therapy addresses this entire system paying extra special attention to the top and bottom (parasympathetic) to help calm the body. Any stressful daily situations involve increased sympathetic (spinal) activity. The Cranio-Sacaral system balances the nervous system from top to bottom or bottom to top.

The popularity of the polyvagal theory has been consistantly rising over the last 15 years. Craniosacral therapists find it valuable and important, but it is still only one nerve in the body. As mentioned, the head contains both sympathetic and parasympathetic branches of nervous system via the cranial nerves. The are 12 cranial nerves of which 4 of them are parasympathetic. The third oculomotor nerve involves functions of the eye. The seventh, the facial nerve, is active in facial expression and parts of taste and hearing. The ninth, the glossopharyngeal nerve, involving throat and mouth, communicates with cranial nerve ten or vagus. Vagus is an interesting nerve in that it exits the head and innervates heart, lungs, and upper 2/3 of the gastrointestinal (a word no stranger than craniosacral) system.

Craniosacral therapy understands the importance of the vagal nerve, but it doesn’t lose sight that there is the other 1/3 of the GI, urinary, and reproduction systems that receive their parasympathetic nerves from the sacral region. Also taken into consideration is the entire sympathetic chain from the spine that innervates all organs. There is a considerable amount of theorizing involving the vagus nerves which are all important and informational. Craniosacral therapy actually addresses this nerve directly, often at its most important juncture, where it leaves the skull at the jugular foramen. Interferences with vagus are very common at the base of the skull/top of the neck. A simple and relaxing correction at this area helps balance everything below. It is important to note that Cranio-Sacral treatment would also address sacrum balancing ALL the parasympathetics, not just one popularized branch.

So what is Craniosacral Therapy anyway?

There is a lot of confusion as to whether Craniosacral therapy is its own modality or is a set of techniques that can be used in other modalities. The answer to this question is both. There are many Craniosacral techniques that are used in adjunct treatments. Also, since it’s conception, there have been many variations and styles that have been developed. For the sake of simplicity and understanding, which is what we are trying to accomplish in this blog, I will break Craniosacral down into two parts, then we will dissect them a little deeper. Essentially there are Craniosacral practitioners using the “Upledger” model and those using the “Biodynamic” model. Let's begin with Upledger as it very common and more accessible.

According the Upledger website, the Institute offers 4-5 day courses in what is written as CranioSacral therapy with a capital C and S. Generally speaking if you see it written that way you will be treated by an Upledger trained therapist. So what does that mean? There are 4 CranioSacral (CS) weekends courses one can be trained in for certification. The first two weekend are the prerequisites then after the third weekend, you can test for the CranioSacral Techniques" (CST) certificate. After the fourth weekend they offer "CST Diplomate" certification.

Most Upledger trained practitioners generally call themselves or their treatments CranioSacral therapy. It is irrelevant whether they have taken one or four weekend courses, most use the CranioSacral title. If you are receiving a CranioSacral treatment, make sure to ask if they are Upledger trained and how many courses they have completed. Those practicing the Upledger method can take many more courses than simply those four, and those who do, tend to be more experienced CranioSacral practioners.

The Upledger Institute offers many courses in many major cities around the US and is usually taught in a hotel setting. Not only does this make it very accessible, but you are not required to attend trainings in the same city or have the same instructor for every course. This means you can space out your weekend courses over a span of time that works for you. This type of accessibility has really helped spread the CranioSacral name, but again, be aware of the varying levels of skill set when you receive treatment.

CranioSacral Therapy considers itself a manual therapy, but unfortunately it is not regulated as a modality. Most states require licensing in some other form of hands-on/manual therapy to be able to legally practice. For this reason you find a lot of massage therapist trained in CS. In fact there is a very high probability that if you are receiving CS from a massage therapist that they are trained in Upledger. You will often find massage therapists use CranioSacral techniques as “part” of their massage. This can often signal low levels of training in the field of CranioSacral.

Another high target audience are physical therapist/physiotherapist (non-US version of Physical Therapy). Because Upledger is considered a Manual Therapy, it fits in well with Physical Therapy (PT) and the Occupational Therapy (OT) model. Both PT and OT practitioners can legally place their hands on people, and both usually have an insurance billing code for manual therapy, which makes it all the more inviting. Often CS is not part of their regular treatment, it is more often an additional service performed on its own, meaning it is treated like its own therapy but under another heading. If you are receiving CranioSacral from a PT, you can almost count on it being in the Upledger format.

The information presented here is important to understand. I speak to lots of people who have tried Craniosacral and yet 95% of them don’t know which format or if it was blended with something else. If you have ever had more than one massage in your life, you may have noticed how different each person and treatment can be. This can be partially due to their own skill set but also to their specific training. If you identify the entire massage field based on one deep tissue massage then you might think all massage is painful. This would create a very narrow viewpoint. Craniosacral can and does have wide range of treatment methods and styles. This point brings us to the second type of Craniosacral Therapy, that of the “Biodynamic” model.

The Biodynamic format can be associated with two groups of Craniosacral theorist. The first is that of trained Osteopaths, and then there is everyone else. Let’s start there. The non-osteopathic version of Biodynamic Craniosacral is attributed to a man name Franklyn Sills. Consequently he was trained as an Osteopath, but intentionally did not finish the curriculum. The biodynamic model does not consider itself a manual therapy although is uses gentle hand placements on the body. It focuses on subtle rhythms in the body that require well trained hands to palpate. Some feel it is an energy based therapy, but the best practitioners are well trained in anatomy, especially the movement of bones. The bio in biodynamic has Greek and Latin origins meaning “life,” just as biology is the study of living organisms. The dynamic language can signify many meanings, i.e, constantly changing activity or force that stimulates changes.

This group is also not state regulated and the same is true for all aspects of this hands-on modality. You will find many more psychotherapists trained in this format as it compliments somatic based behavioral health adjunctive treatments such as Somatic Experiencing or polyvagal based work. Although not regulated, it is overseen by the The Biodynamic Craniosacral Therapy Association of North America (BCTA/NA). To be a member of this organization you must have trained at BCTA/NA approved school. These schools are required to provide a 700 hour training. Considering the state requirements for Massage ranges from 300-1000 hours with most ranging between 500-700, biodynamic schooling is quite thorough. Because of the unique sensitivity of the work, the BCTA/NA also requires schools to have a one teacher to five students (5:1 ratio). If the graduated student meets the standards of the BCTA/NA, they receive the designation Registered Craniosacral Therapist or RCST as opposed to CST if you do not join. If you ask a Craniosacral Therapist if they are biodynamically trained and they say no, then likely they are trained in Upledger or an intro course from their massage program.

This brings us to our last group of people: the Osteopaths. Osteopaths usually do not say they practice Craniosacral, instead they practice Cranial Osteopathy or Osteopathy in the Cranial Field. They have their own Biodynamic version as well. They call it the Biodynamic approach of Osteopathy in the Cranial Field or often Biodynamics of Osteopathy. Perhaps the reason for their strict verbal usage is the the fact that all Craniosacral modalities originated from one man who happened to be an osteopath. (find out more about him in part 2)

Osteopaths in the US are referred to as osteopathic physicians and they are medically trained doctors. This means that on top of their four years of medical school—followed by internships, residencies, and fellowships— they also received 200 hours of hands on Osteopathic Manipulative Medicine (OMM). Usually addition post-graduate training is involved for those specializing in the cranial field. The simple question to ask this group of cranial practitioners is “what country were you trained in?” The United States is the only country that osteopathy is a medical doctorate. Everywhere else in the world it is Masters degree or diploma. Either group is especially well trained in the human body. Most US DO’s do not practice manual medicine, while in most parts of the world that is the only way they practice.

Well, what about Chiropractors? Chiropractors have there own Craniosacral format that they call Sacro-Occipital Technique

(SOT). Sacro or sacrum and occipital or occiput (the cranial bone at the base of the skull). Essentially chiropractors reversed the order of the name and slightly modified it. SOT was originally formulated by Major Bertrand DeJarnette (more in part 2). “The Major” was a chiropractor AND an osteopath, so there you go!

It is clear that Craniosacral and all its formats and versions have their origins in Osteopathy. In fact it was one man who discovered and coined the term. Again, we will discuss him more in Part 2. Now you have deeper understanding of what Craniosacral is, it’s varying styles, and the different parts of the body treated. Part 2 addresses the question of the Craniosacral treatment itself: what exactly will be going on while you lie on the table? What exactly is it therapists are doing? See you next month for all the answers. FYI Craniosacral is not a scalp massage ...

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