Craniosacral Therapy and Visceral Manipulation for Pain Relief
What is Craniosacral Therapy (CST)?
Craniosacral Therapy is rooted in the practice of cranial osteopathy, which was developed in the early 1900’s by Dr. William Garner Sutherland. A form of osteopathy, Sutherland asserted that gentle manipulation around the head and spine can help with a wide variety of conditions throughout the body due to its interconnectedness. While cranial osteopathy has been around since the early twentieth century, it wasn’t until the 1970s that Dr. John Upledger developed Craniosacral Therapy. An osteopathic physician, Dr. Upledger served as a clinical researcher at Michigan State University where he conducted extensive studies on CST.
A gentle hands-on approach that releases tensions deep in the body to relieve pain and dysfunction and improve whole-body health and performance, CST employs the use of light touch to evaluate and enhance the function of the craniosacral system, including the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. By using this very soft touch, CST practitioners are able to assess and support the release of restrictions felt within the craniosacral system thus improving the function of systems within the body. CST facilitates the body’s natural healing process and is practiced by physical therapists, occupational therapists, massage therapists, osteopaths, chiropractors, and acupuncturists.
Can Craniosacral therapy help patients suffering from chronic pain?
According to Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials which appeared in BMC Musculoskeletal Disorders in December 2019, the answer is yes. The meta-analysis of ten randomized controlled trials suggests that patients with chronic pain experienced “robust effects” on pain and functioning that lasted up to six months. The 681 patients that were included in these trials suffered from various pain conditions including neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain.
Craniosacral Therapy for the Treatment of Chronic Neck Pain, A Randomized Sham-controlled Trial that appeared in the Clinical Journal of Pain in May 2016, concluded that CST was “both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention.”
What is Visceral Manipulation (VM)?
Developed by osteopath Jean-Pierre Barral, Visceral Manipulation is a delicate manual therapy that focuses on the viscera, the internal organs of the body. The word "Viscera" relates to the internal organs of the body, such as the liver, kidneys and intestines. Visceral Manipulation aids your body's ability to release restrictions and unhealthy compensations that cause pain and dysfunction. As other osteopathic approaches, VM, does not focus solely on the site of pain or dysfunction, but evaluates the entire body to find the source of the problem. The VM therapist feels for altered or decreased motion within the viscera, as well as restrictive patterns throughout the body and then applies the specific techniques that will release the restrictions. VM therapy also connects and re-establishes the body's ability to adapt and restore itself to health. It is designed to relieve tension within the body and improve connective tissue mobility. VM is part of the standard curriculum at osteopathic schools throughout Europe and has been taught in the United States since 1987.
Can Visceral Manipulation help patients suffering from chronic pain?
Effect of Osteopathic Visceral Manipulation on Pain, Cervical Range of Motion, and Upper Trapezius Muscle Activity in Patients with Chronic Nonspecific Neck Pain and Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Pilot Study which appeared in Evidence-Based Complementary Alternative Medicine in November 2018, indicated that “a single session of osteopathic visceral manipulation for the stomach and liver reduces cervical pain and increases the amplitude of the upper trapezius muscle EMG signal immediately and 7 days after treatment in patients with nonspecific neck pain and functional dyspepsia.”
According to CranioSacral Therapy and Visceral Manipulation: A New Treatment Intervention for Concussion Recovery which appeared in Medical Acupuncture in August 2017, concussed patients who received ten session of CST, VM and NM (neural manipulation) experienced “statistically greater improvements in pain intensity, ROM, memory, cognition, and sleep.”
To learn more about Craniosacral Therapy and Visceral Manipulation, the Alternative Pain Treatment Directory spoke with physical therapist Maryann Herklotz, owner of White Pine Physical Therapy in New York City. Prior to establishing her own practice, she worked for 20 years at Memorial Sloan Kettering. Herklotz specializes in treating musculoskeletal and neurological conditions, dental and sinus conditions, post-surgical concerns, and cancer-related medical issues. The majority of her clients work with her for treatment of their pain.
What sparked your interest in Craniosacral Therapy and Visceral Manipulation?
I was about seven years into my career as a physical therapist when I became increasingly interested in finding additional ways to help patients with cancer successfully manage their pain. Traditional physical therapy was helping them rebuild their strength and mobility, but they were still experiencing significant levels of pain. I sought out other treatment modalities that could complement the skills I had learned as a physical therapist, and that’s when I enrolled in my first class on Visceral Manipulation. Shortly after that, I took my first class on Craniosacral Therapy.
Can you start out by telling us more about Craniosacral therapy?
As cerebrospinal fluid travels through the membranes of the brain and spinal cord, it creates a pulse, felt as a widening and narrowing, called the craniosacral rhythm. This rhythm is something that can be felt and palpated throughout the body. When restrictions of the rhythm are detected, it indicates that movement is restricted in or around that area. Trained practitioners of CST apply gentle but very clear touch to ease those restrictions to restore the natural movement.
Does it require any special instruments to detect this rhythm?
It does not. Trained practitioners can detect craniosacral rhythm by placing their hands on the head, sacrum, the spine, and so on. It can be felt anywhere on the body because of the effect the rhythm has as it travels through the body’s tissues.
How much pressure do you have to apply in order to detect these restrictions?
It requires a very light touch on the body’s various listening points. I use my hands–not my ears– to listen. I start at the head and also listen at the feet, the sacrum, and the midline of the body–from the top of the sternum to down below the navel. My hands are able to feel the quality of the rhythms and detect asymmetries or areas of absence of rhythm that may exist.
What happens next?
I conduct an assessment to determine where the rhythm doesn’t feel as strong or where it may be absent, asymmetrical, fast, or slow. It may feel as if something is being held in the tissues in a certain area. These are all indicators that a movement restriction is present in the tissues. I am brought to a certain area based on the rhythms that I detect. It takes practice, it takes being still, and it requires the practitioner to trust what they are feeling. This work is so subtle. The assessment of movement, rhythm, or the lack of rhythm, will lead the practitioner to the affected area. It is not based purely on knowing what typically causes what, but trusting what is felt.
Is it difficult to feel these rhythms?
It is not difficult with the training. The most important thing to understand when first learning this work is to be very light in the hands, and fully relaxed, otherwise it is possible for the hands to go past the rhythm. I remember being quite surprised that I was able to sense the rhythm during my initial training class. That was fourteen years ago, and since that time, I have expanded my training within Craniosacral Therapy and Visceral Manipulation, as well as Neural Manipulation. It’s important to keep up with the new learning opportunities. I attend several classes every year.
When did you begin incorporating CST into your work for patients with cancer, and how was it received?
Initially, I would incorporate it into sessions to address my patients’ pain concerns, such as headaches or neck pain, as well as range of motion limitations related to tissue changes after surgery or radiation. After I began incorporating both Craniosacral Therapy and Visceral Manipulation into my sessions, patients would report improvements in pain, as well as improved sleep, appetite, and sense of relaxation. Many responded so well to it that they would ask for their entire session to be focused on CST and VM. It felt as if this had been a missing link in helping them manage their pain, to be used in addition to their medical care and other treatment.
Can you tell us more about Visceral Manipulation?
Like Craniosacral Therapy, Visceral Manipulation is based on feeling rhythm through the use of gentle touch. Viscera means organs, and our organs have inherent motion. We all know that our heart is beating and that our lungs move with our breath, but all of our organs have additional motion, referred to as inspir and expir in VM. Our organs are held by fascia, a thin casing of continuous connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. Sometimes restrictions in the fascia around the organs or in the limbs can impact one another.
Can you give me an example to illustrate the concept?
Sure. Clients often come to me with back pain. Working from a traditional physical therapy standpoint, I will look at where the patient is experiencing pain. Some of what I assess are their overall posture, flexibility, motion, and their muscle strength, tone and tension. I will learn about their activities and history. Beyond this, it is necessary to also address the visceral system due to the associated fascial connections to the spine. If there’s a restriction in the visceral system, that could be where the cause of the pain lies. The kidneys and intestines should certainly be assessed. The kidney fascia is associated with the quadratus lumborum and psoas major muscles, and connects with the upper lumbar spine. For example, I may detect that one of the kidneys does not fully express its visceral motion, it may feel tight or restricted. Through a specific visceral manipulation technique using very gentle touch, a release of the fascial restriction is encouraged which can then take the pressure off the spine and nerves at the level of spinal tension as the alignment is rebalanced.
Without my training in Visceral Manipulation, I would never think to look at the motion of an organ to help a client with a diagnosis of back pain.
Do you typically use both Craniosacral Therapy and Visceral Manipulation when treating clients?
I always assess both the craniosacral and visceral systems. By listening to the rhythms, I am led to the areas where I need to work. As I just illustrated when discussing back pain, sometimes where it hurts is not where the cause is.
For example, I’ve had a lot of success treating clients with recurring headaches. When someone is suffering from any type of headache, there is often tension or tightness in the cranium and the sub-occipital muscles, however there may also be tension in the low back, the sternum, or the thoracic cage. Many times, it is the pelvis and the sacrum that is out of alignment. That’s the other end of the craniosacral system, so when that’s off, the tension can travel up the spine and affect the nerves that are causing headache symptoms.
How long does it take clients to experience a reduction in pain?
It depends on the client and the cause. The sooner we find the cause, the sooner they feel better. Typically, we see some type of improvement after the first visit. I have had clients come to me for acute, shorter-term concerns get better in one session. My clients who have more chronic pain concerns come for sessions on a more regular basis, such as every week, while others see me once a month, or as needed. I find that clients who are experiencing an acute onset of pain typically experience faster results. If a client does not experience an improvement, I will refer them to follow up with their physician for a check-up, and collaborate with them as necessary.
Can you give us an example of how you have helped a client suffering from chronic pain?
The majority of my clients see me for issues related to pain. I work with children as well as adults, and one of my middle-school-aged clients was diagnosed with Lyme disease and was suffering from severe headaches as well as back and leg pain. When he first got on my table, I was barely able to detect any rhythm in certain areas of his craniosacral system. Most of the restrictions that I found on the first visit were in his sacrum and head. I used gentle hand placements to ease the restrictions.
After the first session, he experienced such significant results that both of his parents accompanied him for his next appointment. They were there to express their appreciation, as one of the parents shared with me that it was the first time in over a year that their son felt that much better.
Needless to say, that was quite rewarding to me as a practitioner. For me, it is always about finding the best way to help my clients. It’s why I do what I do, and even though I have been practicing CST and VM for many years, there are still days where I am amazed by how effective it is.
Written By Christine Graf.
Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.
