CranioSacral Therapy - Study Guide

CranioSacral
Therapy I
Study Guide
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CranioSacral Therapy I
Study Guide
John E. Upledger, DO, OMM

Illustrations by Frank Lowen, LMT, NCTMB
COPYRIGHT NOTICE
COPYRIGHT © 1987 BY UI PUBLISHING
Revised 7/2010
All rights reserved.
No part of this study guide may be reproduced or

transmitted in any form or by any means
without the written permission of the publisher.
For additional copies of this study guide, please call
THE UPLEDGER INSTITUTE, INC.
1-800-233-5880
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The Upledger Institute, Inc . ®
Workshop Admission Policy
Continuing-education workshops conducted by The Upledger Institute are designed to augment the
professional practices or educational programs of healthcare practitioners. Admission requires
each participant to hold a current healthcare license or certificate, or be enrolled in an educational
program granting licensure or certification. Upon course completion, participants must also
assume responsibility for understanding which techniques fall within the scope of their practices.
Special consideration may occasionally be given to laypersons who wish to attend our
workshops. In these cases, The Upledger Institute carefully evaluates personal and/or professional
circumstances. If granted a waiver of our licensure/certification requirement, the layperson must
sign a consent form stating that completion of an Upledger workshop will not, by any means, provide
licensure or certification for hands-on bodywork.
The modalities taught in these workshops demand a solid anatomical and physiological working
knowledge. Therefore, all participants must assume responsibility for advance preparation.
Policies, Procedures and Code of Ethics Relating to
the CranioSacral Therapy Curriculum
We are pleased to provide you with this training opportunity. We hope that you benefit greatly
from this experience and that you apply the concepts and techniques with success in the future.
It is essential that the purity of this work and the high-quality teaching standards that have been
established for this curriculum are maintained. As such, if you wish to present or teach any por-
tion of the copyrighted material from this workshop, you must first undergo the required training
and/or obtain written permission from The Upledger Institute.
Upon course completion you are invited to take advantage of the Institute’s many ongoing
programs and resources. Information is currently available to help you successfully:
• Submit a press release on your continuing education experience and clinical practice
• Get articles published on techniques, applications, client cases and more
• Form a study group
• Sponsor workshops in your area
• Train to become an instructor or presenter
• Network as a technique demonstrator at trade shows
Please let us know your area(s) of interest. We will gladly assist you in determining the most pro-
ductive use of your assets, as well as support you in organizing presentations, etc. Working
together will ensure that the information presented is current, correct and professionally supported
with collateral materials.
As a practitioner using therapies taught through The Upledger Institute, Inc.®, you are expected
to adhere to the highest professional standards. Among these are the commitment to provide qual-
ity therapy to all persons without discrimination, to seek educational opportunities to enhance
therapeutic skills, to respect each client’s right to privacy, and to accept the responsibility to do no
harm to the physical, mental and emotional well-being of self, clients and associates.
Insurance reimbursement policies vary for manual therapies. If insurance reimbursement is an

integral part of your practice, we encourage you to verify insurance acceptance for your profession
in your state/locale.
Finally, attendance at this training is not intended to be used as a hands-on license. You must
work within your professional scope of practice and abide by the rules and/or laws that govern
healthcare practices in your applicable region (i.e., city, state or province).
If you have any questions about these or other issues, please contact Educational Services at
1-800-233-5880.
A Note From the Editor
Welcome! Thank you for choosing this seminar. You’ll enjoy many learning opportunities
in this CranioSacral Therapy course:
• Explore the history, principles and neuromuscular basis of

CranioSacral Therapy, and its clinical importance.
• Learn to conduct a thorough evaluation using the craniosacral rhythm

as a guide.
• Formulate therapy strategies.
• Perform CranioSacral Therapy techniques to help normalize common

restrictions and dysfunctions.
Thanks again for attending this seminar. We hope this will be an enlightening and
productive experience for you.
ACKNOWLEDGMENTS
I would like to thank all the therapists, students and patients/clients who have contributed to our
work. Their combined efforts help make the CranioSacral Therapy program a great success.
— Dr. John Upledger

Preparing to Learn
Upledger seminars offer a helpful mix of theory and practical work. This workshop will provide
you with many concepts and skills that will enhance your assessment and therapeutic capabilities.
Rather than subtracting from your existing knowledge or skills, it will serve to build upon it.
1. Efficiency Factor — Knowledge

— Action
— Wisdom
2. Paradigm (i.e., frame of reference)

“Each of us tends to think we see things as they are, that we are objective.
But this is not the case. We see the world, not as it is, but as we are — or
as we are conditioned to see it.”
Stephen R. Covey
3. Belief System (i.e., frame of reference based on a feeling of certainty)
“Remember, as long as you believe something, your brain operates on auto-

matic pilot, filtering out input from the environment and searching for
references to validate your belief, regardless of what it is. People with
beliefs have such strong levels of certainty they are often closed off to
new input.”
Tony Robbins
TABLE OF CONTENTS
Introduction......................................................................................................................1
Palpation ..........................................................................................................................9
Fascia and Diaphragms ................................................................................................23
Occipital Cranial Base and Lumbosacral Decompression ........................................53
Semi-Closed Hydraulic Craniosacral System ............................................................91
Dural Tube....................................................................................................................103
Still-Point Induction ....................................................................................................113
V-Spread ......................................................................................................................125
Intracranial Membrane System ................................................................................137
Temporomandibular Joint and Temporal Bones......................................................175
Protocol for Evaluation and Care ..............................................................................203
Bibliography ................................................................................................................207
CranioSacral Therapy Curriculum Flow Chart ......................................................A-1
The Upledger Institute and Its Educational Curriculums ......................................A-2
International Alliance of Healthcare Educators® Curriculums ..............................A-4
Submitting Your News Release ..................................................................................A-5
Model for Research Case Study or Single-Subject Design......................................A-7
UI-Approved Study Groups ......................................................................................A-8

INTRODUCTION
This CranioSacral Therapy Study Guide is intended to supplement both the CranioSacral
Therapy textbook by John E. Upledger, DO, OMM, and Jon D. Vredevoogd, MFA, and the Cran-
ioSacral Therapy workshops taught by The Upledger Institute.
CranioSacral Therapy is a hands-on method of improving health and function. As a student of
this healing art, you begin as an apprentice. There are facts to be learned and skills to be mastered.
Armed with these facts and skills, you must practice, practice, practice.
Ultimately, you’ll arrive at a point where the distinction between facts and skills dissolves. What
is known and what is experienced become one as you progress through apprenticeship to
competency. Hopefully, this study guide will assist you in this process.
There are several ways in which this study guide can help you as a beginning student of
CranioSacral Therapy:
1. By initially focusing your attention on the most important facts to be learned
and skills to be mastered.
2. By drawing together different aspects of CranioSacral Therapy from the
textbook and the workshops into a succinct, coherent whole.
3. By providing additional instruction on CranioSacral therapeutic skills to
supplement both the textbook and the workshops.
4. By providing a format for continued study and practice.
5. By serving as a reference source. Since the study guide pulls together material
from both the workshop and textbook, it can serve as a convenient reference.
Remember: Textbooks, workshops and study guides all emphasize one common aspect of CranioSacral
Therapy — it is learned experientially!
Introduction 1
How to Best Use This Study Guide
If you read this study guide prior to attending each day of your CranioSacral Therapy workshop,
you can use it as an overview of the material that will be covered. The list of learning objectives
at the beginning of each chapter will prepare you for the day’s lessons.
These objectives can help you organize the experiential content of the workshops and the factual
content of the textbook. However, do not overly concern yourself with accomplishing these
objectives during the workshop. After reading the following section on Right-Brain/Left-Brain
Learning, you will see that focusing initially on a written list of learning objectives may hinder
rather than help the learning process.
You can make the most of a CranioSacral Therapy workshop by following the written material in
the study guide, consulting the diagrams, and using the model of the intracranial membrane system
provided at the seminar.
Note-taking need not be extensive, as you will want to devote your time to listening to the instructor,
and carefully observing the practical demonstration. There is available space in your study guide
for notes.
You might also find it helpful to use the study guide as a review at the end of each day of the
workshop. After scanning the learning objectives pertinent to that day, you can ask yourself
whether you feel comfortable with each objective. If the objective calls for the recitation of
factual material about the Craniosacral System, you might recite that material to yourself. If an
objective stipulates mastery of a skill, close your eyes and imagine that you are performing that
skill. How well did you do at each objective?
Specific pages of the textbook are referenced in the study guide. If you have questions about
material presented in the study guide, you can consult the appropriate pages of the textbook. You
can also ask questions during the question-and-answer sessions that are part of each workshop
topic, then jot down the answers in your study guide for future reference. Once you have
completed a CranioSacral Therapy workshop, your study guide will prove to be a valuable aid in
your continued practice and study of CranioSacral Therapy.
2 CranioSacral Therapy I
Right-Brain/Left-Brain Learning
One of the most important insights into human learning has come as a result of leading-edge brain
research conducted within the last 20 years. This research studied the change in function that
occurred when the nerve pathways between the right and left hemispheres of the brain were
surgically severed.
Although medical reasons existed for severing the hemispheric connections in the subjects
studied, the resulting change in brain function was quite surprising. It appeared as though each
hemisphere functioned in an independent and different manner. Each side of the brain was better
than the other at a particular type of task. The researchers were further able to generalize which
kinds of tasks were performed well by each side of the brain.
The left side of the brain appeared to be more specialized at performing analytical tasks: the
addition of numbers, spoken and written languages, objective and critical thought, analytical
reasoning, hard sciences and the like. This was in contrast to the right side of the brain, which
fared well in more subjective and intuitive areas: creative music and arts, intangible thought,
three-dimensional representation of objects, imagination and insight. This separation of function
was experimentally verified in a number of split-brain subjects.
Other researchers suggested that, even in people with intact connections between the hemispheres,
some separation of function took place. This led to the popularization of the phrases “left-
brained” and “right-brained,” referring to individuals who functioned primarily on the basis of
rationale and reason as compared to those who functioned more intuitively and in a “feeling” way.
In-depth research in this area has unearthed a more sophisticated view of hemispheric
specialization. No task is purely analytical or objective, nor is it purely insightful or subjective.
Each hemisphere contributes something to the performance of any task, whether that task is
largely analytical/objective or largely insightful/subjective. Furthermore, even in surgically
produced split-brain subjects, recent evidence suggests that one side of the brain can take over
functions normally associated with the other side.
Regardless of the outcome of this scientific debate, the implications for human learning are clear.
Learning is a complex task that requires the integration of both analytical/objective and intuitive/
subjective skills.
A good example of this occurs in the playing of a musical instrument. There are many analytical
tasks to be mastered in playing a musical instrument, like the placement of the fingers, music theory
and metered rhythm. These are mostly left-brain functions. Yet these skills must be tempered by
the artist’s attention to the mood, feeling, expression and creativity in performing the music.
These are mostly right-brain functions. Without right-brain function, the performance might be
technically perfect but rather lackluster and perhaps boring. Without the left-brain function, the
performance might be a jumble of nonsensical sounds which perhaps express the artist’s feelings
but are not musically comprehensible to the listener.
Introduction 3
Most education in our society focuses on left-brain skills at the expense of right-brain skills. A
premium is placed on analysis, deductive reasoning and logic. Intuition, insight and imagination
take a back seat or may even be denigrated and punishable. This is a somewhat paradoxical
situation since most of the great scientific discoveries of modern times have occurred as a result
of insight and imagination rather than analysis and deductive reasoning.
Einstein visualized himself riding on a beam of light and imagined what he would experience in
order to discover the Theory of Relativity. Edison placed himself in a trance-like state called
hypnagosis to bring forth his most important inventions. Crick and Watson played with Tinker
Toys in their discovery of the structure of DNA. Imagination came first, analysis later.
As a beginning student, many of the skills you will need for CranioSacral Therapy are currently
beneath the level of your ordinary awareness, residing more within the subjective or unconscious
realm. Palpating the craniosacral rhythm is a good example. It is a subtle rhythm that requires a
very light touch and an open mind to experience. With a little practice you will be able to elevate
your sensation of the craniosacral rhythm to a level easily accessible to your ordinary consciousness.
If there is a danger in the process of learning CranioSacral therapeutic skills, it is that the
beginning student focuses too heavily on the analytical left-brain side of learning: “Did I do it
right? Did I really, really feel it? I had it, but then I lost it. Everyone else can feel it, why can’t
I? I’ll never be able to feel it.” These are just some of the obstructive questions that analytical
thinking and the left brain throw into the learning situation.
As learners we are not used to relying on our intuitive, imaginative selves. We often let analysis
intimidate us to the point that imagination has no room to express itself. Imagination does not
mean that we are making something up that does not exist. What Einstein imagined actually existed
and was later verified by analysis. But to get to it, he used his imagination to penetrate the obsta-
cles imposed by ordinary awareness. What Einstein discovered was opposed to common sense.
Initially, you may find that many of the CranioSacral therapeutic skills go against your own common
sense. If you find yourself questioning what you feel or don’t feel, try the following steps:
1. Remind yourself that your analytical questioning can be a roadblock to your
actual experience.
2. Remind yourself that there is a sound, scientific basis for all the techniques
within CranioSacral Therapy. Even if you do not know all of this information
now, you can read about it later. That should pacify the analytical needs of
your left brain for awhile.
3. Remind yourself that many people just like you have been taught to use
CranioSacral Therapy successfully, and that there is no reason why you cannot
feel or experience all that these other people have. Trust yourself, and most
importantly, GIVE YOURSELF PERMISSION TO EXPERIENCE WHAT-
EVER COMES INTO YOUR AWARENESS.
4. If all else fails, just imagine that what you are feeling is absolutely true even if
it does not seem to be at the time. Ultimately, it will be true in the same way
that everything Einstein imagined about riding on a beam of light became true.
Light Forces
In CranioSacral Therapy, lighter forces produce better results. This is a paradoxical observation
given the common sense wisdom that “if a little is good, a lot is better.” Applied to the
Craniosacral System, this would mean that if a little force is useful in affecting the system, a larger
force would be even more efficacious. Wrong!
The goal of the CranioSacral Therapist is to be as unobtrusive as possible in evaluating and
treating the Craniosacral System. Given the fact that it is impossible to be totally unobtrusive,
the therapist must use the lightest force possible in CranioSacral palpation and treatment. The clos-
er to the ideal that the therapist can work, the better the results.
There seems to be a natural tendency toward heavy-handedness when working with the body. To
counter this tendency, you may find it helpful to establish a mental discipline of continually
asking yourself the question, “Can I do this with even less force?” If you practice this as you are
beginning to learn the CranioSacral therapeutic skills, you will soon develop the habit of using
only the minimum force necessary to do the technique.
The following three analogies may be of some help in this regard. They give a reference point
for how much force should be used with the Craniosacral System.
1. Imagine a piece of thin cellophane (like that used to wrap food) floating on top
of a bowl of water. The force needed to move the cellophane across the surface
by touching the underside of the cellophane without deforming it is the amount
of force used in the Craniosacral System.
2. Approximate the force needed to raise a nickel with one finger (about 5 grams).
3. Visualize the force used when you comfortably place pressure on closed eyelids.
(No heroics here, please!)
You may wish to experiment with these examples to get a feel for the forces involved in
CranioSacral Therapy.
Introduction 5
A Brief Description of the Craniosacral System and
its Discovery
The Craniosacral System is a recently discovered physiological system. It is a semi-closed

hydraulic system contained within a tough waterproof membrane (the Dura Mater) which
envelops the brain and the spinal cord. An important function of this system is the production,
circulation and reabsorption of Cerebrospinal Fluid (CSF). CSF is produced within the
Craniosacral System and maintains the physiological environment in which your brain and
nervous system develop, live and function.
Normally, the production and reabsorption of CSF within the Dura Mater produces a continuous
rise and fall of fluid pressure within the Craniosacral System. The semi-closed hydraulic system
expands and contracts to some extent with this rhythmical pressure fluctuation. This volumetric
accommodation prevents pressure from building up too much within the Craniosacral System. If
for some reason your body is unable to accommodate these pressure changes, the subsequent
buildup of pressure can contribute to dysfunction and ill health, especially in the Central Nervous
System which is enclosed within the boundaries of the Craniosacral System.
Investigation in this field was begun in the second decade of the twentieth century by William G.
Sutherland, DO. Initially, attention was given only to the cranial bones and their movement at the
cranial sutures, which are the interfacing connections between the cranial bones. Areas of
aberrant cranial bone motion were induced and corrected by manual techniques. Soon therapeutic
techniques were devised to correct abnormal cranial bone motion.
Early exploration of cranial manipulation was performed primarily by osteopaths and chiropractors
who formed societies to investigate and teach cranial methods. These pioneers were at odds with
the larger scientific community, and often with their own peers, over one central aspect of the cranial
system: the movement of the cranial bones.
Conventional anatomical wisdom taught that cranial bones were movable only in young infants,
and were solidly fused in adulthood. The controversy raged on until quite recently.
In the mid 1970s, the College of Osteopathic Medicine at Michigan State University sought to
resolve this controversy. It brought together a team of researchers led by Dr. John Upledger.
Their objective was to prove or disprove the basic tenets of cranial manipulative techniques. The
major premise involved the movement of cranial bones.
By studying fresh cranial bone specimens rather than the chemically preserved specimens that
were studied by previous researchers, the Michigan State University team demonstrated the potential for
cranial bone movement. Optical and electron microscopy showed the existence of blood vessels,
nerve fibers, collagen and elastic fibers within cranial sutures. There was little evidence of sutural
ossification, which would prevent movement of cranial bones in relation to each other.
Further studies conducted by the Michigan State University team utilized radio wave broadcasts
between antennae affixed to the exposed surfaces of cranial bones in adult living primates. This
work yielded precise measurements of the frequency and amplitude of cranial bone movement.
With the existence of cranial bone motion established, elucidating the mechanisms behind this
motion became the next task of the Michigan State University team. It was here that the role of
the Craniosacral Dura Mater and Cerebrospinal Fluid were integrated into a comprehensive
model of the Craniosacral System. They called it the “Pressurestat Model.” This model is fully
described in the section entitled “The Semi-Closed Hydraulic Craniosacral System” in this study
guide.
The results from the Michigan State University research influenced the therapeutic application of
cranial techniques. Previous techniques were primarily based on the movement of cranial bones.
It was now known that the Dura Mater plays a key role in cranial bone movement. Techniques
for evaluating and treating the dural membranes were developed largely by Dr. John Upledger.
It is this central role of the dural membranes in the evaluation and treatment of the Craniosacral
System that differentiates CranioSacral Therapy, as taught by The Upledger Institute, from other
cranial techniques. Therefore, in your study of CranioSacral Therapy you will continually find
this interplay between osseous and membranous aspects of the Craniosacral System.
Introduction 7
Notes:
PALPATION
Objectives:
1. To develop an appreciation of palpation potential.

2. To be able to palpate cardiac pulse, breathing movement and craniosacral
rhythm anywhere on the body — singularly and in concert.
3. To familiarize yourself with the three “vault holds” or hand positions.
4. To become familiar with the terms “flexion” and “extension” in relationship to
the Craniosacral System.
5. To become familiar with the movements induced by flexion and extension
anywhere in the body.
Palpation 9
Palpation
Palpation is the art of using touch to examine the body. Through palpation you can explore the
structures beneath the skin — their forms, movements and relationships to each other. The normal
or abnormal function of an organ can be discovered. The mobility of a joint with its muscular,
ligamentous and tendinous attachments can be evaluated. The flow of body fluids can be sensed.
The motion of one bone in relation to another can be felt. Even the electromagnetic field
surrounding the body can be monitored by palpation.
There are a wide array of palpatory skills available to the practitioner. Placed on a continuum,
these skills range from intrusive to nonintrusive, from active to passive, from firm contact to little
or no contact at all.
At one end of this continuum is intrusive or invasive palpation, which uses firm, heavy force to
probe beneath the skin’s surface. Often the use of a heavy palpatory force evokes an equally
strong response from the area of the body being examined. Muscles tighten, pain reflexes are
initiated and the body defends against the palpator’s hand. The information gained from such pal-
pation may tell more about the body’s defensive mechanisms than about the underlying
condition which may be the subject of the palpatory search.
At the other end of this continuum is nonintrusive palpation, which permits examination without
evoking resistance. It is this method of palpation which is most useful to the CranioSacral Therapy
practitioner. Nonintrusive palpation allows the therapist to experience a sense of “melding” with
the client. Like a dry sponge placed in a pool of water, information seems to be absorbed through
the practitioner’s hand. In this situation, it is important that the therapist accept whatever
information is received. As we mentioned earlier, this information will often seem paradoxical to
your analytical, rational mind. Even if you are not sure, accept what you experience as true.
The remainder of this chapter is devoted to helping you develop your skills in palpation. You will
palpate the cardiac, respiratory and craniosacral pulses at various locations on the body.
Palpation Types and Styles
Gross Subtle
Active Passive
Palpation 11
Palpating the Cardiac Pulse
Almost everyone has taken his or her pulse at some time (palpated the cardiac pulse). The cardiac
pulse is created by the rhythmic surge of blood from the heart through the arterial system. It is a
pulse that is easily felt at many locations throughout the body. Ordinarily, this pulse is taken at
the wrist.
Palpate your cardiac pulse using the following steps as a guide:
1. Lightly place your middle three fingers along the radial border of the wrist.
2. Pressing very gently, see exactly how much pressure you actually need to feel
the cardiac pulse.
3. When you have determined the pressure needed to palpate your cardiac pulse,
lighten your pressure even further and see if you can still feel the pulse.
4. Repeat step 3 several times until you have reached the absolute minimum force
needed to feel the pulse.
5. Make some observations:
• Timing or beat of the pulse – fast or slow?
• Amplitude of the pulse – large or small?
• Quality of the pulse – robust or weak?
• Morphology of the curve of the rise and fall of pressure
• Other sensations about the pulse that you receive
The cardiac pulse is easily palpated in other locations. Repeat steps 1 through 5 above, on yourself
first, in at least two additional areas:
• Midline abdomen about 2 centimeters above the navel
• Femoral artery on the inside of the thigh where it joins the pelvis
• 1 centimeter directly posterior to the medial or lateral malleolus
• Anywhere along the carotid artery in the neck
• Any other location on the body
Palpating the Respiratory Pulse (Breathing Motion)
The respiratory pulse is produced by the movement of the rib cage and the diaphragm as they
assist in the constant filling and emptying of the lungs during breathing. It is conveniently palpated
almost anywhere on the anterior chest surface. Palpate your own respiratory pulse by placing
your hands lightly on your chest. Follow the same five steps used in palpating the cardiac pulse.
Once you have become familiar with your respiratory pulse at the chest, move your hands to
another station. Just like the cardiac pulse, the respiratory pulse can be palpated almost anywhere
on the body. This is not the ordinary way of palpating the respiratory pulse, but it can be done.
Some suggested locations for palpating the respiratory pulse are:
• Abdomen
• Anterior Thigh or Calf
• Ankles
• Shoulders
As you palpate the respiratory pulse in these different areas, ask yourself how the tissue
underneath your hands is moving in response to the respiratory pulse. Is it rotating, expanding
and contracting, or moving up and down? Allow the answer to come through your hands.
The cardiac pulse can be felt in every location you palpated a respiratory pulse — and vice versa.
Now, add the following steps to your palpation:
1. Select an area and palpate the cardiac pulse as indicated above.
2. Without moving your hands, palpate the respiratory pulse.
3. Move back and forth between palpation of both pulses without moving
your hands.
4. Superimpose the palpation of one pulse on the other so that you are
experiencing both cardiac and respiratory pulses at the same time.
5. What new information comes from this experience of palpating?
Palpation 13
Palpating the Craniosacral Rhythm
The craniosacral rhythm, like the cardiac and respiratory pulse, can be felt throughout the body.
Also, like the other pulses, the craniosacral rhythm has a distinctive character at different locations
in the body. You will learn to use palpation of the craniosacral rhythm as a means of monitoring
the function of the Craniosacral System. The craniosacral rhythm will tell you where the system
is operating normally or abnormally. It will also indicate the success of your therapeutic efforts to
reestablish normal function. Learning to palpate the craniosacral rhythm is the foundation of
successful CranioSacral Therapy.
The craniosacral rhythm is reflected throughout the body. However, the actual movement at various
body locations differs slightly. Perceiving the response of the body to the craniosacral rhythm is the
first step in successful CranioSacral Therapy.
The expansion phase of the Craniosacral System is termed flexion, while the contraction phase is
termed extension. Thus it is said that the cranium expands during flexion and contracts during
extension.
What are the movements made by the other parts? Fill the answers in as you discover them by the
use of palpation.
BODY PART FLEXION MOVEMENT EXTENSION MOVEMENT
Paired Bones
Single Bones
Begin by palpating your own craniosacral rhythm. Start palpating at your head by interlacing your
fingers and placing your palms lightly around your parietal and temporal bones. It will help if you
rest your elbows comfortably on a table. It is important that your body be comfortable and relaxed
during palpation. This will assist you in receiving as much information as possible from your efforts.
Since you are familiar with the cardiac and respiratory pulses, palpate them first. Then remove them
from your awareness and feel the craniosacral rhythm, which is slower than either the cardiac or
respiratory pulse. The craniosacral rhythm occurs with a frequency of about six to twelve cycles per
minute. This means that flexion takes place to a slow count of 1-2-3. There is a slight pause between
flexion and extension, then extension occurs at a slow count of 1-2-3.
Do not force the experience of palpating your craniosacral rhythm. Rest your hands gently on the
head and allow the rhythm to come to you. Once you are able to feel it, go through the five steps
that we initially used to palpate the cardiac pulse. Gradually lighten the pressure until you are using
the bare minimum necessary. It is even possible to sense the craniosacral rhythm from inches off the
body surface!
Having gone through these five steps, next apply the additional steps we used to palpate the
cardiac and respiratory pulses together. Only this time move back and forth between all three
rhythms. Finally, superimpose all three rhythms on each other. What sensations did you receive?
A concert pianist was once asked how he could remember the involved musical passages of a
piece he was playing. “Very easy,” he said. “I try not to let my mind distract my hands while they
are playing.”
The more you practice palpating the craniosacral rhythm, your hands will develop skills and
wisdom of their own. Try not to let your mind distract your hands. Let your hands play a beautiful
concerto, and through palpation you will learn to hear the music and communicate with the
intelligence of the body.
As your skills develop, you will want to feel for the different aspects of the craniosacral rhythm:
Symmetry
Quality
Amplitude
Rate
When feeling for symmetry in the Craniosacral System, you evaluate how even the flexion and
extension movements are in relation to each other. Symmetry also can be evaluated bilaterally in
either flexion or extension.
When evaluating quality, you feel how smooth the motion is during the flexion and extension
phases. Quality can also be determined by how much vitality the system exhibits during its motion.
Amplitude is the measurement of how far the body moves in flexion and/or extension.
Rate is simply how fast the body moves through one cycle, and how many cycles per minute.
Listening Stations
To use the craniosacral motion as an evaluation tool, palpate the rhythm throughout the body to
determine where the body fascia is restricted and where it is moving efficiently. The following is
a list of general “listening stations” that will give you a general, overall evaluation of craniosacral
motion throughout the body:
Heels
Dorsums of the Feet
Anterior Thighs
Anterior Superior Iliac Spines
Ribs
Shoulders
Cranial Vault Holds (three)
Palpation 15
Notes: Three Vault Holds
First Vault Hold
Figure P-1
Core Intent: To assess mobility and restrictions of the cranial bones (and relating membranes),
primarily from a medial-lateral perspective.
Hand Placement: Hands and fingers spread out on the lateral aspect of the cranium making
light, conforming contact.
Reprinted from CranioSacral Therapy by John E. Upledger and Jon D. Vredevoogd with permission from Eastland
Press, Inc., P.O. Box 99749, Seattle, WA 98199. Copyright 1983. All rights reserved.
Palpation 17
Notes:
Second Vault Hold
Figure P-2
Core Intent: To assess mobility and restriction of the cranial bones (and relating membranes),
primarily from an anterior-posterior perspective, as well as to focus on the cranial floor.
Hand Placement: One hand “cupping” the occiput while the thumb and fifth fingers of the
other hand make contact with the greater wings of the sphenoid.
Reprinted from CranioSacral Therapy by John E. Upledger and Jon D. Vredevoogd with permission from
Eastland Press, Inc., P.O. Box 99749, Seattle, WA 98199. Copyright 1983. All rights reserved.
Palpation 19
Notes:
Third Vault Hold
Figure P-3
Core Intent: To assess mobility and restrictions of the cranial bones (and relating membranes)
with primary focus on the occiput and sphenoid.
Hand Placement: Both hands “cupping” the occiput with thumbs extending laterally and anteriorly
to the greater wings of the sphenoid.
Palpation 21
Notes:
FASCIA AND DIAPHRAGMS
Objectives:
1. To develop an appreciation of the total-body fascial system and its transverse

diaphragms.
2. To develop experience and confidence in the perception of tissue “release” and
“therapeutic pulse.”
3. To be able to obtain tissue release of the Pelvic Diaphragm.
4. To be able to obtain tissue release of the Respiratory Diaphragm.
5. To be able to obtain tissue release at the Thoracic Inlet (Outlet).
6. To be able to obtain tissue release at and relating to the Hyoid.
7. To gain a working knowledge of the anatomy of the Pelvic Diaphragm, the
Respiratory Diaphragm, Thoracic Inlet (Outlet) and the Hyoid.
Fascia and Diaphragms 23

The Fascial System
The fascia of the body is the tough connective tissue which holds us together. It keeps our livers
from falling out, our lungs and heart from exploding, our intestines from falling down into the bottom
of our pelvises, and it envelops each and every structure of the body. The tiniest nerve has its own
fascial sheath or envelope, as does the largest bone. About half of the muscular attachments of
the body are to fascia, so that muscle tone or the state of contraction have a lot to do with how
tight or loose the fascial sheaths and envelopes are in certain areas of the body at any given time.
Fascia has been described in various ways. It has been called the body stocking under the skin
which helps to hold us together. It has been described as tubes within tubes within tubes. It has
also been viewed as a series of lamina which cohere, separate into envelopes, and cohere again.
In the latter view, each body structure has its own envelope formed between the fascial lamina.
All of these views are appropriate and correct. The superficial fascia does form a body stocking.
The meningeal layers are tubes within tubes within tubes. And each body structure or viscus has
its own private envelope of fascia which is formed by the separation of two or more fascial lamina.
Four things are important for the CranioSacral Therapy practitioner to appreciate about the fascia:
1. The majority of fiber orientations for the fascias of the body are in a general
longitudinal direction.
2. At given areas of the body, transversely oriented fascias act as supports for the
body to prevent uncontrolled lateral expansion of the torso. These are the
diaphragms of the Pelvis and Thorax, as well as the Thoracic Inlet (Outlet).
3. The total-body fascia is a single system. We can travel from any one place in
the body to any other place without ever leaving the fascia. A clear example is
as follows: We may begin in the Falx Cerebri, move into the Tentorium
Cerebelli, travel down the lining of the internal aspect of the Occiput and end
up at the Carotid Foramen in the Temporal Bone. At this juncture we can
(without leaving the fascia) continue our journey down the Carotid Sheath,
which becomes the Pericardium in the Thorax. We can travel down the fascial
fibers of the Pericardium, which pierce the Respiratory Diaphragm. Once
through this diaphragm, we can travel down its inferior fascial covering to the
fascia of the Psoas muscle. We can follow the Psoas fascia into the Pelvis and
then into the leg. From this point on it is a straight journey to the bottom of
the foot. Because we can make this journey to anywhere in the body using the
fascia as a vehicle, we know that all body parts are interconnected by the
fascia. This means that abnormal tension patterns in the fascia may be
transmitted from one body part to another in what appear to be most bizarre
ways unless one appreciates the “oneness” of the fascial system.
4. Body fascias are mobile to some extent under normal circumstances. They allow
for physiological and subtle body movements, offering little or no
resistance; they also allow for gross body movements such as throwing a ball.
They let your heart beat and your lungs expand.
Among the more subtle physiological body movements which fascia normally
allows is the rhythmical internal and external rotation of the total body in
compliance with the so-called flexion and extension activities of the Craniosacral
System. We can clearly perceive with our proprioceptors the total-body movement
allowed by the fascia in response to our breathing efforts and the pumping of
blood throughout our bodies.
Notes:

Tissue Release
Tissue Release, or simply Release, is the name we have applied to the sense of softening and
relaxation that is perceptible when the technique in use has come to a successful completion. This
does not mean that the whole session is over, just that this phase is finished.
There are probably multiple factors involved in the Tissue Release phenomenon. One or all of
these factors may be involved in any one perceived Release.
These factors are:
1. Relaxation of nervous reflexes which have produced increased tissue tone.
2. Tissue morphological change from elastic resistance to viscous compliance.
This indicates a lengthening of tissue fibers without biomechanical memory
for the return to their original dimensions.
3. A sense of increased passage of fluids through the tissues under treatment.
4. A sense of increased flow of energy through the tissues under treatment.
5. An emission of increased heat radiating from the appropriate body region.
6. A sense of a repelling force as perceived by the therapist’s hand when palpating
the involved area.
7. There may be a sense of crescendo and decrescendo of the Therapeutic Pulse
related to the Release. This Therapeutic Pulse is described in more detail on
the following page.
A Tissue Release must be experienced to be comprehended. It feels like the tissues loosen and
move laterally in a reasonably symmetrical manner.
Common Signs of Release:
1. Softening
2. Lengthening – this means you’re into collagen
3. Increased fluid flow
4. Increased energy flow
5. Heat
6. Energetic repelling – feels like opposing magnets
7. TP – Therapeutic Pulse (this will fade)
8. Client takes deep breath
Any change in the tissue can be considered a sign of release.
Therapeutic Pulse
The Therapeutic Pulse is a phenomenon that we have observed on many occasions when the
subject’s body is in the process of self-correction. It may occur anywhere on or in the body under
treatment. The amplitude of the Therapeutic Pulse seems to increase from near zero until it comes
into the conscious awareness of the therapist. It is not the Cardiac Pulse, although it seems almost
the same when you first experience it. The high-amplitude Therapeutic Pulse may last seconds or
minutes. Its presence seems to indicate that something good is occurring. After the self-correction
is complete, the Therapeutic Pulse diminishes in amplitude until it becomes imperceptible. It is
my policy not to change whatever I am doing while the Therapeutic Pulse is perceptible.
Notes:

Notes: Clinical Considerations
Diaphragm Release
Core Intent: To mobilize major (and common) areas of transverse fascial dysfunction.
Pelvic Diaphragm of the Female
(Viewed From Above)
Levator Ani Muscle

Urogenital Diaphragm Pubes
}
Pubovaginalis
Puborectalis
Urethra
Iliococcygeus
Vagina
Rectum Arcus
Tendineus
Coccygeus Muscle
Ilium
Sacrum
Figure F-1

Notes:
Schematic Diagram of the Female Pelvis
(Viewed From Above)
Urethra Pubovesical
(Pubocervical Ligament)
Cervix
Loose Endopelvic
Fascia
Lateral Cervical
(Cardinal) Ligament
Uterosacral (Round)
Ligament
Schematic Diagram of the Male Pelvis

(Viewed From Above)
Puboprostatic Ligament
Prostate
Lateral Ligament of Bladder
(Prostate)
Loose Endopelvic Fascia
Sacrogenital Ligament
Figure F-2

Notes: Pelvic Diaphragm Release (Reference CranioSacral Therapy, pp. 49-52)
Hand Placement: Posterior hand — Transverse under L5-S1 and sacrum.

Hand Placement: Anterior hand — Hypothenar eminence contacting the superior
aspect of the pubic bone with the rest of the hand contacting superiorly.
Gentle Compression
Pubic Bone
Femur
Sacrum
Figure F-3

Notes:
Respiratory Diaphragm
Anterior View of
the Diaphragm
Figure F-4

Notes:
The Undersurface of the Diaphragm
Central Tendon
Muscular Part of Diaphragm Xiphoid Process
Lower
Rib Cage
Inferior
Esophageal
Vena Cava
Opening
Aortal Left
Passage Crus
Left Quadratus
Lumborum
Left Psoas Major
Right Crus
Figure F-5

Notes:
Notes:

Notes: Respiratory Diaphragm Release (Reference CranioSacral Therapy, pp. 46-49)
Hand Placement: Posterior hand — Transverse under T12-L1.

Hand Placement: Anterior hand — Contacting ribs borders/xiphoid process.
Hand Position for Diaphragm Release
Figure F-7
Lateral View of Diaphragm Release
Figure F-6

Notes:
Superior View of Thoracic Inlet Area
Second Rib
Manubrium
First Rib
Clavicle
First
Thoracic
Vertebrae
Scapula
Figure F-8

Notes:
Lateral and Anterior
Views of Muscles of
Neck and Thoracic
Inlet Area
Of interest are the many divergent

directions of function of these tissues,
showing the complexity of pulls and
balances that may be upset and Figure F-9
lead to potential dysfunctions.

Notes:
Picture on left shows major arteries of the
head as they pass through the Thoracic Inlet.
Picture on right shows major veins and

sinuses as they drain into Thoracic Inlet.
Figure F-10

Notes: Thoracic Inlet Release (Reference CranioSacral Therapy, pp. 52-57)
Hand Placement: Posterior hand — Transverse under C7-T1.

Hand Placement: Anterior hand — Thumb and second finger contacting sternoclavicular
joints/clavicles.
Hand Position for Thoracic Inlet Release
Figure F-11

Notes: Hyoid Release
Hand Placement: Posterior hand — Fingers “cupping” the cervical spine with the
second finger in contact with the occiput.
Hand Placement: Anterior hand — Thumb and second finger on the anterior cornua of the
hyoid bone.
Hand Placement and Technique for
Release of the Hyoid
Gently following
Hyoid
Middle
Constrictor
Inferior
Constrictor
Continuity of connective
tissues around cervicals
(from Pharyngeal
Constrictor Muscles)
Hand behind
neck
Figure F-12

Addendum
Any abnormal contraction of the diaphragms just released may produce a “drag” on the Craniosacral
System as evaluated from the head or the feet. It is therefore suggested that the participant
evaluate the quality of the Craniosacral System’s activity from both the head and the sacrum before
and after releasing each of the four diaphragms previously described.
This exercise will begin to give you an appreciation of the impact upon the Craniosacral System
function produced by diaphragmatic restriction.
Notes:
OCCIPITAL CRANIAL BASE AND
LUMBOSACRAL DECOMPRESSION
Objectives:
1. To gain appreciation of the anatomical complexity and vulnerability of the

Occipital Cranial Base.
2. To gain experience and develop proficiency in the Release technique for the
Occipital Cranial Base.
3. To mobilize the Sacrum.
Occipital Cranial Base 53

General Considerations
The Occipital Cranial Base is another region of the body where there is an increase of transversely
oriented myofascial tissue. It is the area at the inferior or lower part of the skull where the Occiput
connects to the Atlas (the first cervical vertebra), and where the Atlas and the Axis (the second
cervical vertebra) join together to form a functional unit.
In addition to its lateral joints with the lower surface of the Atlas, the Axis provides a bony pillar
called the Dens around which the Atlas rotates.
Notes:
Posterior View of
Occiput-Atlas-Axis
Occiput
Dens
Atlas
Axis
Posterior View of
Occiput-Atlas-Axis
Separated to Show Articulations
Occiput
Condyle of Occiput
Superior Facet
of Atlas
Inferior Facet of
Atlas
Superior Facet of
Axis
Axis of Rotation
around Dens
Occiput and
Atlas and Axis separated
Condyles (cut)
to show how Atlas can
rotate around Dens
Facet and
Lateral Process
of Atlas (cut) Axis
Figure O-1

Notes:
Lateral view of Atlas and Axis
Dens showing unique shape of facets,
which allows for a great deal
Atlas of gliding during rotation of
atlas on axis.
Inferior Facet of Atlas
Superior Facet of Axis
Axis
Lateral View of Facets of Atlas-Axis From Left Side
These pictures show how the

shapes of these facets create a
slight side bend to the head
during rotation (of the head).
A Rotating to right
B Neutral
C Rotating to left
Lateral view of facet mechanics of

C3-C7 during rotation.
• Compare to facets of the Atlas-Axis
Those at left allow for a more limited
degree of sliding with rotation.
Figure O-2

The Condyles of the Occiput form joint surfaces with the upper articular surfaces of the Atlas.
These joints allow mostly for forward and backward bending of the Occiput on the Atlas (the head
on the neck).
Notes: Occiput and Atlas Joint Surfaces
Head in “Neutral”
Upright Position
Forward
Bending
Condyle
Occiput
Dens Atlas
Axis
C3
Mandible
Backward
Bending
= Area bearing weight or stress
Extreme
Backward
Bending
“Jamming” of Condyles into Facets of Atlas
Condyles
Facets of
Atlas
Figure O-3

Notes:
(Anterior)
Angles of Facets Superior Articular Facets
Atlas:
Superior View
Atlas: Oblique Anterior View
Angles of
Occiput:
Articulations Posterior View
Angles of Posterior-
Condyles
Inferior View
Atlas
of Condyles
These pictures show angles of articulations that can Figure O-4

contribute to jamming between Occiput and Atlas.

If we look at the Occiput, the Atlas and the Axis together, we see a kind of universal joint with
the Atlas in the middle. The motion between the Atlas and the Occiput is largely flexion and
extension (or forward and backward bending). The motion between the Atlas and the Axis is largely
rotational.
The muscles at the Occipital Base are about 1-1/2 inches thick. In order to release the Occipital
Cranial Base, we must relax the muscles and disengage or “gap” the joints.
Occipital Cranial Base Release
Part One: Direction of energy with gradual platform to release the soft tissues posterior
to the atlas
Part Two: Full platform to disengage the atlas from the occiput
Part Three: Decompression of occiput from atlas
Part Four: Lateral spread of occipital condyles to alleviate foramen magnum restrictions
Part Five: Superior traction of the dural tube to release restrictions in dural tube

Occipital Cranial Base Release, Part One
Core Intent: To release restrictions and facilitate relaxation in the soft tissues posterior to the atlas
Hand Placement: Fingertips of both hands placed posterior to the atlas, hands together, head
resting in the palms of the hands.
Technique: Using the fingertips, gradually engage the tissues one gram at a time (as with diaphragm
releases), in an anterior direction towards the atlas adding direction of energy to assist, until soft
tissues relax and release and you can feel your fingertips in contact with the atlas
Figure O-5
Occipital Cranial Base Release, Part Two
Core Intent: To disengage the atlas from the occiput

Hand Placement: Fingertips posterior to the atlas as in Part One, hands together, wrists straight,
metacarpophalangeal joints flexed, straight fingers angled towards the orbits of the eyes, creating
a platform posterior to the atlas with your fingertips
Technique: Maintain the platform in proper position, allow the weight of the head to assist the
occiput while the atlas rests on the fingertips until the atlas disengages and floats freely
Figure O-6

Occipital Cranial Base Release, Part Three
Core Intent: To decompress the occiput from the atlas

Hand Placement: Index fingertips in contact with the atlas, palmar surface of middle and/or ring
fingers in contact with the occiput, hands together, head resting on palms
Technique: Provide gentle, 5 grams superior traction to the occiput with the middle and ring
fingers while index fingers gently stabilize the atlas
Figure O-7
Occipital Cranial Base Release, Part Four
Core Intent: To spread the occipital condyles laterally and release restrictions in the foramen
magnum
Hand Placement: The palmar surfaces of all fingers in contact with the occiput, hands together,
head resting in palms
Technique: Apply gentle lateral traction with both hands
Figure O-8

Notes:
Occipital Cranial Base Release, Part Five
Core Intent: To evaluate for and release dural tube restrictions and mobilize the dural tube in a
superior direction
Hand Placement: Head resting in the hands, cradling the occiput (as in 3rd vault hold)
Technique: Apply a gentle superior traction using the occiput as a handle to access the dural tube.
Be careful not to recruit muscular resistance. When you feel a restriction (or resistance to the
superior traction), gently maintain the superior traction until you feel release, the dural tube
lengthen and/or the occiput float towards you.
I like to compare this technique to pulling a large boat in the water. If you put the rope around
your little finger and just barely pull, the boat will move toward you with very little effort on your
part. Otherwise you can break your back pulling without much better success. The Dural Tube
will come toward you; just be patient.
Effect of Occipital Traction on the

Dural Tube and Sacrum
Sacrum
Spinal Dural Tube
Foramen
Magnum
Occiput
Figure O-9

Notes:
Venous Drainage Through Jugular Foramina
Sagittal View
Lateral Sinus
Sigmoid Sinus
Occiput
Jugular Foramen
Petrous Portion
Exit Point for Jugular Vein
of Temporal
IX - X - XI Cranial Nerves
Bone
Foramen Magnum
Jugular Vein
Jugular Foramina
Jugular Veins
Squama of Temporal Bone
Petrous Part of Temporal Bone
Sigmoid Sinus
Straight Lateral
Sinus Sinus
Superior View
Superior Sagittal Sinus
Occiput Figure O-10

Addendum
The Occipital Cranial Base Release technique improves the efficiency of fluid outflow from the
cranial vault. It also alleviates pressures on the Glossopharyngeal, Vagus and Spinal Accessory
Cranial Nerves. Both of these benefits are accomplished largely by releasing any abnormally
increased tissue tonus around the Jugular Foramina (reference CranioSacral Therapy, pp. 291-297).
Notes: Jugular Foramen
Occipital Cranial Base/Jugular Foramina
Temporal
Occiput
Jugular Foramina Exit

Point for Jugular Vein
IX - X - XI Cranial
Nerves
Jugular
Foramen
Brain Stem
IX - X - XI
Cranial Nerves
Medulla
Oblongata
Figure O-11

Notes:
Cranial Nerve IX – Glossopharyngeal Nerve
Pons
Fourth
Ventricle
Medulla
Oblongata
Internal
Carotid Artery
Parotid Gland
Soft Palate
Palatine Tonsil
Tongue
Stylopharyngeus
Muscle
Carotid Sinus
Figure O-12

Notes:
Cranial Nerve X
Pons Vagus Nerve
Fourth
Ventricle
Picture below shows major branches

Spinal
and ganglia of Vagus Nerve.
Cord Medulla Oblongata
Pharynx
Epiglottis
Thyroid Cartilage
To Heart (cut) Left Bronchus
Esophagus
Stomach (cut)
Liver (cut) Spleen
Gallbladder Pancreas (cut)
Left Kidney
Ascending (Duodenum)
Colon (cut)
Small
Intestine
Also Transverse Colon (cut)
(not shown)
Ileum (cut)
Cecum Figure O-13
Appendix
Notes:
Cranial Nerve XI – Spinal Accessory Nerve
Pons
Fourth
Ventricle
Medulla Oblongata
Figure O-14

Mobilizing the Sacrum
While stabilizing the lower Lumbar Vertebrae with one hand, apply a gentle but persistent traction
in a caudal direction with the other. Do not use enough force to recruit muscular resistance. This
technique should release lumbosacral compression. If not, use the straight legs as levers to gap
the lumbosacral juncture by flexing the Pelvis around your other hand, which acts as a fulcrum.
Notes: Lumbosacral Release Through Traction
Core Intent: To decompress the sacrum inferiorly from L5.
Hand Placement: One hand posterior to sacrum (between legs) with other hand stabilizing
L3-4-5 with fingertips or finger pads.
Traction Release of L5 - S1
Figure O-15
For hand position – see Figure O-16

Notes:
Traction Release of L5 – S1
Please note —
The fingers of the hand under the lower Lumbar
Vertebrae may be held open with the finger pads
against the Spinal Process.
Figure O-16

Medial Compression of
Anterior Superior Iliac Spines
In order to release the Sacroiliac Joints, you will find that a medial compression of both Anterior
Superior Iliac Spines (ASIS) simultaneously in the supine client will allow the Sacrum to move
more freely. This may be done either by you or the client. Medial compression of these spines
tends to gap the joints in the back. While they are gapped, glide the Sacrum up and down (supe-
riorly and inferiorly) a few times to mobilize the joints. This will also help many dysfunctions of the
Sacroiliac.
Notes:
Core Intent: To release both Sacroiliac (SI) Joints.

Hand Placement: One hand posterior to sacrum with the other arm’s fingertips and
forearm on the ASIS.
Medial Compression of ASIS
to Release SI Joints (Iliac Gap)
Figure O-17

Notes:
Patient-Assisted Release of SI Joints via
Medial Compression of the ASIS
Figure O-18

Notes:
Using the Sacrum to Evaluate
and Mobilize the Dural Tube
Now that the Sacrum is free, use a very light traction on the Sacrum toward the feet. Do not recruit
muscle resistance. Wait and you will feel the Dural Tube move toward you. Evaluate its mobili-
ty. Try to discern any restrictions to mobility and try to localize them. One way to mobilize the
dural tube would be to hold light traction (5 grams) against the restriction until lengthening
occurs.

Notes:
SEMI-CLOSED HYDRAULIC
CRANIOSACRAL SYSTEM
Objectives:
1. To obtain a functional, working comprehension of the Craniosacral System as

a semi-closed hydraulic system through the “Pressurestat Model.”
2. To obtain a clear anatomical picture of the Dural Membrane as the boundary
of this semi-closed hydraulic system.
3. To obtain a detailed understanding of the bony attachments of the Dural
Membrane and how these bones and membranes interact.
Semi-Closed Hydraulic Craniosacral System 91

The Pressurestat Model
A semi-closed hydraulic system is one in which there is a closed container with a regulated inflow
and outflow mechanism. That is, fluid can be put into and removed from the container at controlled
rates of flow. In this way the quantity of fluid within the container at any given time can be regulated.
If fluid is pumped into the container after it is full and at one atmosphere of pressure, and if the
container cannot further expand its volume, the following conditions may occur: 1) the pressure
inside of the container is increased until either the container springs a leak or explodes; 2) the
pressure inside the container exceeds the pumping force which the inflow pump can produce;
3) the outflow system is opened to remove some fluid; or 4) the inflow pump is shut off.
This description fits the Pressurestat Model of the Craniosacral System.
1. The container is the waterproof and relatively inelastic but very strong Dura
Mater. The Dura Mater membrane is shaped like a tadpole with the head inside
the skull vault and the tail extending downward within the vertebral canal (formed
within the spinal vertebrae) to the Sacrococcygeal Complex where it is anchored.
2. The fluid in our semi-closed hydraulic system is the Cerebrospinal Fluid. This
is an extract of the blood that has circulated through the Choroid Plexuses of
the brain’s ventricular system.
3. The inflow pumping system consists of the Choroid Plexuses, which are located
mostly in the Lateral Ventricles of the brain. However, (inconsistently) there
may be some Choroid Plexus present in the Third Ventricle of that system.
4. The regulatory system for the rate of fluid (CSF) inflow into our container (the
polliwog-shaped sac formed by the Dural Membrane) probably includes more
than one subsystem since Mother Nature seems to always provide “back up”
in everything she designs. The one fluid input regulatory subsystem we do
know about is the neuromechanism which involves stretch and compression
receptors in the sagittal suture. These receptors communicate (via nerve tracts
running through the Falx Cerebri and then into the brain substance) with the
Ventricular System and its Choroid Plexuses. When the sagittal suture is
stretched open by increased fluid pressure within the Dural Membrane container,
the stretch receptors send a neural signal down to the Choroid Plexuses to either
stop completely or significantly reduce the production of Cerebrospinal Fluid.
This change in CSF production amounts to stopping or significantly reducing
the inflow of fluid into our semi-closed hydraulic system. When the sagittal
suture compresses (one parietal bone against the other), a nerve signal is gener-
ated by the pressure receptors and sent to the Choroid Plexuses in the
Ventricular System of the Brain, which causes the CSF production to begin
again. Since the rate of inflow of fluid into the system exceeds the rate of
outflow of fluid from the system, the internal pressure of the Dural Membrane
sac or container rises until the signal is again received to shut down the
production of CSF.
Under normal circumstances the system seems to operate on about a six-second
cycle. That is, CSF is produced for about three seconds and then the
production system is shut down for about three seconds. This gives us the
rhythmical rise and fall of fluid pressure within the system.
The Dural Membrane that forms the waterproof boundary of our semi-closed
hydraulic system is the internal lining of the bones that form the skull vault.
As such, it is firmly attached to these bones. When the Dural Membrane sac
is pumped full of fluid, it expands to tautness up to a given pressure level.
Since the parietal bones are attached to the Dural Membrane on their complete
internal sides, as the Dural Membrane sac expands to tautness, the sutures
between the attached bones are expanded. When the internal fluid pressure
is reduced, the elastic tissue within the sutures causes them to close to the
prescribed dimension.
5. The regulation of Cerebrospinal Fluid outflow from the semi-closed hydraulic
system (Dural Membrane sac) is probably also accomplished by several
subsystems. The one subsystem with which I am familiar involves a cluster of
Arachnoid Granulation Bodies, which are located at the extreme anterior end
of the Straight Venous Sinus. This sinus is formed by the juncture of the Falx
Cerebri, the two sides of the Tentorium Cerebelli and by the Falx Cerebelli.
The location of this cluster of Arachnoid Granulation Bodies at this juncture
of all of the intracranial membranes seems crucial. Tension from anywhere
within the Dural Membrane System seems able to be transmitted to this
particular location in the membrane system. The Arachnoid Granulation
Bodies clustered there seem to have the ability to increase or decrease the
general rate of reabsorption of CSF from within our semi-closed hydraulic
system. This is more of a baseline regulation which, I suppose, is sensitive to
general internal pressures and tensions within the system. It might be compared
to the idling speed of your automobile engine, which is more or less constant
unless adjusted by using the adjustment screw on the carburetor. This is a
baseline rate of operation, whereas the input side of the system is rising and
falling rhythmically all the time.
The outflow system from our Pressurestat Model is represented by the
reabsorption of CSF back into the venous blood system as accomplished by the
Arachnoid Villae, located in many parts of the Dural Membrane System but are
most concentrated in the sagittal venous sinus.
These, then, are the components of our hypothesized model of the Craniosacral System.

Notes:
Pressurestat Model Illustration

Notes:
Oblique, Posterior-Superior View
Showing Sutures, Membranes and
Ventricles of Brain
As the cranium expands during the flexion

phase (due to the rise in CSF pressure), the
parietal bones move apart A at the Sagittal
Suture, sending a stretch reflex signal down a
nerve fiber(s) B into the area of the Ventricu-
lar System C where the Choroid Plexuses of
the Ventricles D * act as the vehicles for
CSF production.
— This signal (down the Nerve Fiber(s) to the
Ventricular System) is to turn off or slow down
production.
— As CSF drains, this cycle is reversed, i.e.,
Sagittal Sutures approximate creating pressure
(at sutures), thereby signaling for CSF pro-
duction to resume.
* Shown are a portion of the Choroid Plexuses
of the third and lateral ventricles only.
Sagittal
View
Figure P-1
Posterior
View
Arrows indicate
blood flow
from cerebral
hemispheres to
great cerebral
vein and
straight sinus. Central position of Arachnoid Granulation Cluster (ball-valve
mechanism) regulates outflow based on membrane tension.
Any tensions in the membrane system can reflect back into this
central area.
Therefore, abnormal tensions anywhere in the system potentially
can have a disruptive effect upon this mechanism — and its
effect upon CSF production.
Anatomical Relations
The Dura Mater, which forms the sac of the semi-closed hydraulic system, is attached as the inner
lining to the Parietal Bones, the Temporal Bones, the Frontal Bone, the Occipital Bone and the
Sphenoid Bone. It also attaches to the Ethmoid Bone but not as its lining.
The Dura Mater also forms the tube which runs downward through the vertebral canal. Within
the canal, its only bony attachments are to the posterior bodies of the second and third cervical
vertebrae and to the posterior body of the second sacral segment. It exits the vertebral canal through
the Sacral Hiatus and blends with the periosteum of the Coccyx. The Dural Tube within the
vertebral canal is also firmly attached to the Foramen Magnum of the Occiput. Otherwise, the Dural
Tube attachments are either soft tissue ligaments (Dentate) which allow some movement of the
Dural Tube or the Dural Sleeve attachment to the Foramina formed by the vertebrae for the passage
of spinal nerve roots outside of the Spinal Canal.
The Falx Cerebri, Tentorium Cerebelli and the Falx Cerebelli all represent Dura Mater (Dural
Membrane) structures inside of the cranial vault, which are formed by the Dural Membrane separating
from the skull bones and reduplicating upon itself to form partitions in the skull. These structures also
provide much of what is used in the formation of the Venous Sinus system inside the skull.
Notes:
Points of Attachment of Dura … to Bone … (Schematic)
Entire
Cranial Vault
Foramen
Magnum
C-2
C-3
Coccyx S-2
Points of Attachment of Dura … (Detail)
Attaches to and
lines entire
Cranial Vault
Blends with Posterior
Anterior portion Around entire
Periosteum of bodies of
of Canal of S-2 Foramen Magnum
Coccyx C-2, C-3
Figure P-2

Notes: General Outline of Venous Sinuses

The Venous Sinuses
(Arrows indicate direction of venous drainage.)
Anterior View
Superior
Sagittal Sinus
Falx Inferior
Cerebri Sagittal Sinus
Tentorium Straight Sinus

Cerebelli
Falx Lateral Sinus
Cerebelli
Superior
Jugular Petrosal Sinus
Foramen Sigmoid
Sinus
Foramen
Magnum
(Views of Falxes, Tentorium Cerebelli and Sinuses)
Posterior-Superior View
Falx Cerebri
Superior
Sagittal Sinus
Tentorium
Cerebelli Inferior
Sagittal Sinus
Straight Sinus
Superior
Petrosal Sinus
Jugular
Foramen
Sigmoid
Sinus
Lateral
Falx Sinus
Cerebelli Jugular Vein
Foramen Magnum
Figure P-3

Notes:

DURAL TUBE
Objectives:
1. To sense by palpation and proprioception the quality of Dural Tube mobility.

2. To release any abnormal restrictions or tensions that interfere with Dural Tube
function.
3. To have at your fingertips the concept of the interrelations between the involved
bones and the Dural Tube.
Dural Tube 103

The Dural Tube
We have talked briefly about the Dural Tube. The main points to keep in mind are that the Dural
Tube must have a reasonable degree of freedom of movement within the Spinal Vertebral Canal
and in relationship to the Arachnoid Membrane. Otherwise, we lose most of our ability to bend and
rotate our spines without severe pain. Also, it must be remembered that the Dural Tube connects
your head to your upper neck and to your tail. Problems in any of these areas can broadcast up and/
or down the tube to present symptoms elsewhere. An injured coccyx can cause a headache, etc.
Remember that the Dural Tube attachments are:
Superior attachments
• Dense fibrous ring around Foramen Magnum.
• Within the spinal canal at level of second and third cervical vertebrae (anteri-
or tube attaches to posterior bodies of the vertebrae).
Inferior attachments
• Within sacral canal at level of second sacral segment — anterior aspect of
dura attaches to anterior wall of canal through sacrum (posterior body of
segment).
• Blends with other meninges to exit sacrum and becomes periosteum of the
coccyx.
Now let us consider how we might deal with the Dural Tube.
Technique — Dural Tube evaluation and treatment/release.
Objective — Mobilize the Dural Tube to its maximum.
Enabling Objectives — Mobilize Occiput and Sacrococcygeal Complex.
The Occiput was mobilized when you applied the Occipital Cranial Base Release Technique.
The Sacrococcygeal Complex was partially mobilized when you released the Pelvic Diaphragm.
We must, however, be sure that the Sacrum is not compressed at the Lumbosacral Junction and that
the Sacroiliac Joints are not binding free sacral movement. It is impossible to use the Sacrum as
the handle to evaluate the more subtle movements of the Dural Tube if the Sacrum itself is not free
to move. The same is, of course, true of the Occiput.

From Both Ends
Now that you have approached the Dural Tube from either end individually, we will approach it
from both ends at the same time.
Dural Tube Rock

With the client supine, place one hand under the Occiput and the other hand under the Sacrum.
Encourage a gentle rocking between the two ends using the craniosacral rhythm. The rocking
motion will address the rotational aspect of the Occiput and Sacrum. In doing so, you will help to
release restrictions of the transverse rings of fascia in the Dural Tube. The more you rock, the better
the Dural Tube will like it.
Notes: Rocking the Dural Tube
Core Intent: To release transverse rings of the dural tube and enhance the rotational range of
motion of the occiput and sacrum.
Hand Placement: One hand transverse under the occiput and the other transverse under the
sacrum.
Dural Tube 105

Notes:

Rocking the Dural Tube — Supine
Figure D-2
Dural Tube 107

Notes:

Rocking the Dural Tube
Figure D-3
Dural Tube 109

Dural Tube Glide
With the client and your hands in the same position, “tune-in” to the longitudinal motion at the
Occiput and Sacrum. (This motion is happening simultaneously with the rocking/rotational motion.)
By enhancing this longitudinal motion, you address the nerve roots as well as any remaining
restrictions of the Dural Tube within the vertebral canal.
Restrictions are freed by moving the Dural Tube. Be patient and move it through several cycles.
It is also helpful to use prolonged traction on a restricted Dural Tube. Simply hold and await the
release just as you did with the other bones of the cranial vault.
Notes: Gliding the Dural Tube
Core Intent: To release spinal nerve roots and dural sleeves and enhance longitudinal range of
motion of the occiput and sacrum.
Hand Placement: Same as dural tube rock.

Gliding the Dural Tube — Supine
Figure D-4
Dural Tube 111

Notes:

STILL-POINT INDUCTION
Objectives:
1. To gain a working knowledge of what the Still Point represents and how it occurs.
2. To understand the indications, uses and contraindications for the Still Point.
3. To develop the skill to induce a Still Point from anywhere in the body.
4. To be able to use the CV-4 technique.
Still-Point Induction 113

Still-Point Induction
This is the first time during the course of this workshop that you, the CranioSacral Therapy
practitioner, will actually intrude upon and alter the function of the Craniosacral System.
For therapeutic reasons, we are going to intentionally interrupt the workings of the Craniosacral
System. To review, the flexion phase of the craniosacral rhythm is the time when the whole body
externally rotates. The extension phase of the craniosacral rhythm is when the whole body internally
rotates. During flexion the head widens and the base of the Sacrum moves posteriorly. We theorize
that the flexion phase of the rhythmical cycle is created when the input of Cerebrospinal Fluid (CSF)
into the semi-closed hydraulic system formed by the Dura Mater exceeds the outflow. During the
extension phase of the rhythm, the input of CSF is either shut off completely or is significantly less
than the outflow. Thus, we might say that the flexion phase is one of filling and the extension phase
is one of emptying.
We can induce a Still Point by either resisting the flexion or extension phase. It is easier and more
efficient to resist the filling (flexion) than the emptying (extension). Remember, flexion is bodily
external rotation and widening of the head. Extension is bodily internal rotation and narrowing of
the head.
Notes: Still-Point Induction
Core Intent: To bring the CSR to a (gradual) therapeutic stop, facilitating greater homeostasis.

Notes:

Notes: Still-Point Induction by CV-4
Core Intent: To bring the CSR to a therapeutic stop, specifically through the occiput.
Hand Placement: With the palms facing up (toward the ceiling), place one hand over the other
with the thumbs touching each other. Leaving the thenar eminences apart (approx. 1.5-2.5”),
center the occiput on the soft tissue of the thenars.

CV-4 Still-Point Induction
Arrows indicate direction

Thenar Eminences follow
Occiput to induce Still Point.
Figure S-1

Notes: Still-Point Induction Through the Sacrum
Core Intent: To bring the CSR to a therapeutic stop, specifically through the sacrum.
Hand Placement: One hand centered under posterior sacrum (between the legs).

Still-Point Induction Through the Sacrum
Arrows indicate direction of “following” into extension.

Dotted lines indicate “new” position of Sacrum after each extension phase.
Figure S-2

Notes: Still Point on Legs
Core Intent: To bring the CSR to a therapeutic stop through the legs.
Hand Placement: Any bilateral location on the legs.

Still-Point Induction Through the Legs
Arrows indicate
direction followed into
internal rotation of the
lower extremities.
Figure S-3

Notes:

Indications, Uses and Contraindications
The Still Point is used as a balancing technique for the Craniosacral System. It will also remove
transient and minor restrictions with only a few serial applications. Theoretically, its use could
remove most intradural restrictions because, if you redirect and change fluid forces within the system
repeatedly, most restrictions will succumb and release.
The Still Point is used to release accumulated stress. It has a profound relaxing effect on the autonomic
nervous system. Thus, it is beneficial with most hyperautonomic problems, from high blood pressure
to peptic ulcer.
The Still Point also improves fluid exchange between the various physiological compartments of
the body, as well as improving blood flow by reducing sympathetic nervous tone.
DO NOT use the Still Point in cases of acute stroke, cerebral aneurysm, or any condition in
which fluid pressure changes within the skull could be detrimental.
Occasionally, the Still-Point induction will dredge up old pains that had “gone away.” This is
good. The old pains hadn’t disappeared, they were simply dormant and waiting to reappear at
another time. The dredging up offers opportunity for total correction of the problem at that time.

Cranial Pumping
With the discovery of chelating elements in CSF, facilitating fluid exchange through the CS sys-
tem could enhance immune function, promote clearing waste products and increase overall
vitality.
By “pumping” the cranium, you are gently encouraging a greater volume of CSF to be produced
and reabsorbed. Consequently you will be increasing the amount of fresh nutrients to the brain
and spinal cord while collecting more byproducts to be filtered out of the system.
The technique is simple: You are enhancing CSF movement by encouraging 5 grams of move-
ment at the end-range of flexion and extension while palpating the cranium. Typical hand
positions would be: one hand under the occiput and the other on the crown/frontal area. Blend
with the CSR and enhance the motion at the end ranges. The result will be enhanced production
and movement of CSF.
Notes: Cranial Pumping
Core Intent: To enhance the production and movement (exchange) of CSF.

Hand Placement: One hand on crown/frontal area, other hand under occiput.

V-SPREAD
Objectives:
1. To temporarily suspend hypercritical thought processes which may obstruct a

favorable V-Spread experience.
2. To appreciate the similarity between the V-Spread and many other hands-on
therapeutic approaches or techniques.
3. To explore the many ways in which the V-Spread has the potential for healing.
4. To gain several positive V-Spread experiences, both as therapist and as recipient.
V-Spread 125
V-Spread
(Reference CranioSacral Therapy, pp. 74, 139-40, 164-66 and 263)
The V-Spread is the technique that stretches both our credibility and your imagination to the
maximum. It is a technique that is not yet explained in scientific terms, although it seems to be
related to the work of Robert Becker, MD, as expressed in his book The Body Electric, and to the
work of Harold Saxton Burr, described in his book Blueprint for Immortality. Both of these researchers
seemed to do with instrumentation what the V-Spread technique does with the hands (or other body
parts) of the CranioSacral Therapy practitioner. In any case, to effectively and fairly evaluate the
efficacy of the V-Spread technique, you must try it. In order to try it with reasonable fairness, you
will have to temporarily suspend the activity of your critical and rational left brain. If you have a
negative attitude, this may interfere with the result. Once you have experienced the phenomenon
of a successful V-Spread application, it becomes more difficult to deny its existence. In some people
the experience sets up a real conflict between what they perceive and what their intellect tells them
is silly or impossible.
I sometimes think that the V-Spread separates the adults from the children. The adults “know” that
it is a ridiculous waste of time and so reject it. The children don’t “know” that V-Spread is not a
valid technique, and so they use it with success.
In reality, I think the V-Spread is out on the far edge of the frontier. One day we will know how
it works and those who understand it will wonder what all the fuss was about. V-Spread will
become standard operating procedure and will be a part of everyone’s first-aid training, be it from
the Red Cross or the Boy/Girl Scouts of America.
As you practice the technique, some of you will see the close relationship to Krieger’s Therapeutic
Touch, Polarity Therapy, Joy’s Way (by Brugh Joy) and many other approaches.
What makes the V-Spread approach different is its lack of rules and rituals. In V-Spread we simply
decide to direct, pass or organize a “healing energy” for a given purpose and we do it. No
gimmicks or tricks. You can use any method that you decide will work. Yes, it does look like we
are discussing the recruitment of a “healing power” which we all possess and which is directed by
our intention.
It does not matter whether you send from right to left or left to right — all you have to do is decide
that it will work this way. Yes, you can send from off the body. Yes, the energy of two or more
senders can be added together. Yes, release occurs and heat radiates from the area under treatment,
and Therapeutic Pulse occurs. It will crescendo as the healing energy passes through the body parts
being treated and begins to reach your receiving hand. It will decrescendo and disappear as the
therapeutic process is completed. And yes, of course you can do the V-Spread on yourself, but it
takes a little longer and may be less effective. One last comment: The denser the tissue that the
healing energy must penetrate, the longer it takes to reach your receiving hand (or receiving foot, etc.).

Additional Thoughts
As we further our experiences working with energy in the therapeutic setting, we have found that
there are refinements that we can make with our “directing.”
You can be even more effective facilitating release and revitalizing tissue if you first assess the
energetic nature of the tissue in question. Sometimes you will determine that the tissue is deplet-
ed or “over-full.” In these cases you would want to intention to add or remove energy as the tissue
desires for release and balance.
The best way that we have found to determine the energetic needs of tissue is to assess from “neu-
tral.” Neutral is the phenomenon in which the therapist places his/her hand(s) on the effected
tissue, neither adding nor removing energy—they are just “there” with no engaging intention at
all. After just a little practice, you’ll be able to easily determine the needs of the tissue.
Notes:
V-Spread 127
Sutherland’s Concept
Historically within the Craniosacral System framework, the V-Spread is derived from the earlier
observations of William Garner Sutherland, DO, who, during the first half of this century, set out
to prove that cranial bones could move. Dr. Sutherland observed or reasoned that it was possible
to achieve a release of sutural restriction between the skull bones by the direction of energy
through Cerebrospinal Fluid. He pursued this concept practically and demonstrated the method
as a very effective means of releasing abnormally immobilized sutures.
Notes: Direction of Energy Technique to Release Sutures

Sutherland’s Approach
Pain or Restricted Suture
Place pads of fingers gently on the scalp directly over the painful suture area.
Next, imagine a line or vector from the painful area through the center
of the skull and out the other side of the patient’s head.
(Continued on page 131.)
Figure V-1
V-Spread 129
Notes:

Sutherland’s Approach (continued)
Pulsation Area
With the other hand, very gently palpate for a pulsation of the
scalp at the region where the vector would emerge.
A gentle spreading action by

the fingers paralleling the
painful suture will speed the
therapeutic effect.
Once the area of pulsation

has been located, apply finger pads to
the area. The fingers of the other hand gently
parallel the painful suture (on either side of
it). The painful suture will begin pulsating and continue to do so for a matter of
Figure V-2
minutes. As the pulsating subsides, so will the pain.
V-Spread 131
Expansion of Sutherland’s Concepts
Through observation and experience, we have found that the presence of Cerebrospinal Fluid
between the sending and receiving hands is not necessary unless you believe it to be so. The healing
energy can be directed through any body part to achieve a positive result.
Notes: Direction of Energy
Core Intent: To send or remove energy to or from effected areas of the body, facilitating release.
Hand Placement: Anywhere on the body.

Direction of Energy
Technique From
Occiput Through
Eye Into
Cupped Hand
Figure V-5
V-Spread 133
Notes:

Sending Energy
Sending energy from the therapist’s body through the client’s

body (in this case, the liver area) to the therapist’s hand.
Figure V-6
V-Spread 135
Notes:

INTRACRANIAL MEMBRANE SYSTEM
Objectives:
1. To develop palpatory skills which will tell you when you have an osseous
restriction or a membranous restriction, and when the viscous change has
occurred.
2. To develop appreciation for the minute amounts of forces involved in the
craniosacral “lift and traction” techniques.
3. To be able to evaluate and release restrictions in the Intracranial Vertical
Membrane System.
4. To be able to evaluate and release restrictions in the Intracranial Horizontal
Membrane System.
5. To develop an understanding of the difference between osseous and membranous
restrictions.
6. To develop an understanding of the viscoelastic properties of membranes and
how this biomechanical phenomenon can be used in CranioSacral Therapy.
7. To evaluate and treat the Temporal Bones using Temporal Wobble, Finger in Ear
and Temporal Ear Pull techniques.
Intracranial Membrane System 137

The Palpation of Restriction Quality
Before we proceed, we must also have an appreciation for the different kinds of restrictions we will
encounter, and the sensation of release in the intracranial and spinal Dural Membrane systems.
1. Osseous restriction is firm and immovable. This is sutural restriction.
2. Membranous restriction has an elastic quality. It gives when you traction it,
but it seems to want to snap back as you let go.
3. When elastic restriction is ended, a viscous change has occurred and the sense
of elastic recoil or tissue memory is gone. This signifies the completion of that
phase of the therapeutic process.
Evaluation and Treatment of the

Craniosacral System
Evaluation and treatment of the Craniosacral System is accomplished through the application of
very gentle traction or lifting forces. This is a light force directed along the natural pathways of
cranial bone movement in the flexion or extension phases of the craniosacral cycle.
If gentle traction causes the cranial bone to move freely and smoothly through its normal range
of motion, then no underlying restriction exists. Often this will not be the case, and the therapist
will encounter resistance to gentle traction. When resistance is encountered, it is indicative of an
underlying restriction within the Craniosacral System.
Restrictions, which are barriers to free movement of the Craniosacral System, may occur between
adjacent cranial bones or within the craniosacral Dural Membrane. Hence, a distinction is made
between osseous and membranous restriction. These two restrictions provide a different palpatory
sensation for the therapist.
Osseous restrictions are rigid. This type of restriction represents a lack of mobility at the cranial
sutures – often the result of sutural “jamming.” It feels as though the involved cranial bones are
cemented at their sutural junction.
Membranous restrictions are elastic. This type of restriction exists within the craniosacral Dural
Membrane. Under the gentle traction of the therapist, a membranous restriction feels like a rubber
band that has been pulled and is ready to snap back.

Distinguishing between osseous and membranous restrictions is a significant part of the basis for
evaluation and treatment of the Craniosacral System. Although contact points are taken on the cranial
bones themselves, it is more than cranial bone mobility that is evaluated and treated. Osseous
restrictions inhibit normal cranial bone movement. Underlying membranous restrictions interfere
with the normal compliance of the Craniosacral System with the rise and fall of CSF pressure.
The craniosacral membrane system is the first priority target of this therapy; the cranial bones are
simply handles on the underlying membranes. The steps of this process can be outlined as follows:
1. Apply gentle traction in the direction of desired cranial bone movement at the
sutures.
2. If a rigid, cement-like resistance is encountered, an osseous restriction exists.
This must be treated before proceeding. Osseous restrictions, if they exist, will
be encountered before membranous restrictions are sensed.
a. Continued light traction often will release an osseous restriction.
b. The use of a V-Spread through the area of osseous restriction will cause it
to release.
c. The use of a specific osseous manipulation for that suture will bring about
a release.
d. Correction of an osseous restriction occurs when the underlying, rigid
movement barrier is no longer felt.
3. If an elastic resistance is encountered, a membranous restriction exists which
must also be corrected. Membranous restrictions will be encountered either
alone or after the release of an osseous restriction.
a. Continuous light traction will usually release a membranous restriction.
b. Correction of a membrane restriction has been achieved when the elastic
phase of resistance becomes plastic, or pliable, and the involved cranial
bones proceed freely toward the end point of their movement.
4. When the unrestricted movement of the cranial bones and the underlying Dural
Membrane is achieved, therapy is concluded by gently releasing the light traction.
Notes:

Notes:

Spring and Dashpot Model
1) = Viscous element
= Elastic element
Fixed end Resting position (no load)
Piston
Cylinder
2) Elastic element takes up

force of traction (load)
Traction
load is
applied
3)
Time passes –
Pull from spring is transmitted to cylinder
As cylinder moves — fluid is pulled into cylinder (from piston)

4)
Spring returns to “relaxed” position as cylinder
is moved to “new” position from load.
Figure I-1
New position (of tissues) is now resting in a “stable” position
— there is no pull to return to position of #1 (in sequence).
Horizontal and Vertical Divisions of the
Craniosacral Membrane System
For your convenience and reference, the craniosacral membrane system has been divided into
subsystems. These subsystems and the names of the related therapeutic techniques are listed below:
Craniosacral Membrane System

1. Intracranial Membrane System
• Vertical Subsystem
Anterior-Posterior Division
Frontal Lift with Traction
Superior-Inferior Division
Parietal Lift with Traction
• Horizontal Subsystem
Anterior-Posterior Division
Sphenoid Compression-Decompression
Lateral Division
Temporal Ear Pull
2. Spinal Dural Tube
• Superior-Inferior
Occipital Traction
• Inferior-Superior
Sacro-Coccygeal Traction
• Indifferent to Direction
Occipito-Sacral Rocking Technique

Anatomical Attachments of the
Free Craniosacral Membrane System
The anatomical attachments of the craniosacral membrane are considered for each of the four
divisions of the free craniosacral Dural Membrane: (1) the Falx Cerebri, (2) the Falx Cerebelli,
(3) the Tentorium Cerebelli, and (4) the Spinal Dural Tube. These specific anatomical attachments
for these divisions of the Dura Mater are:
1. Falx Cerebri
• Anterior Attachments
Internal Vertical Midline of the Frontal Bone
Crista Galli of the Ethmoid Bone
Ethmoid Notch of the Frontal Bone
• Posterior Attachment
Internal Occipital Protuberance and Vertical Line of the Occipital Bone
• Superior Attachments
Undersurface of Frontal, Parietal and Occipital Bones Along
the Midline and Beneath the Sagittal Suture
• Inferior Attachments
Tentorium Cerebelli
• Related Venous Sinuses
Superior Sagittal Sinus Formed From the Enfolding of Attachments
Along the Sagittal Suture
Inferior Sagittal Sinus Formed at Free Border of Falx Cerebri
Straight Sinus Where the Falx Cerebri Joins the Tentorium Cerebelli
2. Falx Cerebelli
• Superior Attachments
Inferior Leaves of Tentorium Cerebelli and the Straight Sinus
Formed by Their Attachment
• Posterior Attachments
Internal Midline Ridge of Occiput
• Inferior Attachment
Dense Fibrous Ring Around Foramen Magnum

3. Tentorium Cerebelli
• Superior Leaves Continuous with Falx Cerebri
• Inferior Leaves Continuous with Falx Cerebelli
• Anterior Attachments
Anterior Clinoid Process of Sphenoid Bone (Superior Leaves)
Posterior Clinoid Process of Sphenoid Bone (Inferior Leaves)
• Lateral Attachments
Petrous Ridge of Temporal Bones
Mastoid Portions of Temporal Bones
Inferior Angle of Parietal Bones
• Posterior Attachments
Transverse Ridges of Occipital Bone
4. Spinal Dural Tube
• Superior End
Posterior Bodies of C2, C3
• Inferior End
Anterior Portion of Canal at S2
Blends with Periosteum of Coccyx

Craniosacral Techniques for the
Vertical Membrane System
1. Frontal Lift With Traction

• Anterior-Posterior (Reference CranioSacral Therapy, pp. 62, 69-74,
162-164)
Notes: Frontal Lift
Core Intent: To release the sutures of the frontal bone and the anterior/posterior aspect of the
falx cerebri and falx cerebelli.
Hand Placement: Fourth fingers make contact posterior to the lateral ridge of the frontal bone.
Fingers two and three spread out medially on the frontal bone making full, conforming contact.

Notes:

Frontal Lift
Figure I-2

Notes:

Frontal Lift
Figure I-3

2. Parietal Lift With Traction
• Superior-Inferior (Reference CranioSacral Therapy, pp. 77-78, 161-162)
Notes: Parietal Lift
Core Intent: Part One — To release the temporal-parietal suture with medial compression on
the parietal bones followed by a 10-second release of pressure to allow for fluid exchange of the
superior sagittal sinus.
Core Intent: Part Two — To release the superior/inferior aspect of the falx cerebri and falx
cerebelli.
Hand Placement (both parts): Fingers two through five make contact on or around the pari-
etal ridge (temporalis attachment).

Parietal Lift — Part One
1 2 3
C C
A Parietals A A A
B B
D D
Temporals
A) Gentle Medial Compression A) Gentle manual pressure B) Internal fluid pressures now
maintained laterally spread Parietals
B) Internal fluid pressures begin
to lift Parietals C as Figure I-4
sutures disengage D

Notes:

Parietal Lift — Part Two
After appropriate pause at conclusion of Part One, gentle cephalad traction is applied.
Figure I-5

The Horizontal Membrane System
1. Sphenoid
• Anterior-Posterior (Reference CranioSacral Therapy, pp. 74-76, 120-126)
Compression
Decompression
The Unlatching Principle
With Sphenoid compression/decompression, we introduce the concept of an indirect technique.

It’s based on using an “unlatching” principle to release a restriction by encouraging motion in the
direction of ease as opposed to the direction of the restriction. To open a door latch we must
sometimes first exaggerate the closure. For instance, the latches on some kitchen-cabinet doors
or stereo-cabinet doors require you to push in to release the mechanism.
With the Sphenoid technique, we compress the sphenoid into the joint (motion of ease) and attain
releases, then decompress (motion of the barrier) and release the remaining restrictions. Quite
often, the indirect portion of the technique will easily release many of the barrier restrictions
before they are directly addressed.
Notes: Sphenoid Compression/Decompression
Core Intent: Compression — To engage the “unlatching principle” with the sphenoid
and release sutural restrictions.
Core Intent: Decompression — To release the anterior/posterior aspect of the tentorium
cerebelli.
Hand Placement (for both): Thumbs placed on the greater wings of the sphenoid and the rest of
the hands wrap posteriorly around the cranium.

Sphenoid:
Part 1 —
Compression
Hand Position
Figure I-6

Notes:

Sphenoid: Part II — Decompression
Figure I-7

Notes:

Sphenoid Decompression
Figure I-8

Temporal Bone Techniques
Evaluation:
Circumferential motion, Finger in the Ear
Medial-lateral motion, Wobble
Treatment:
Occipital-Mastoid Release
Ear Pull
Re-evaluate and synchronize, if needed

Temporal Wobble
Finger in the Ear:

Evaluation of Circumferential Motion
Core Intent: To assess mobility of temporal-parietal, and other temporal sutures. Can also be
used to re-synchronize motion after treatment if needed. (See Page 166)
Hand Placement: Bilateral, middle fingers gently placed in the external auditory meatus, index
fingers on the zygomatic processes of the temporal bones, ring fingers on the mastoid processes.
Technique: Palpate symmetry, quality, amplitude and rate (SQAR) and synchrony of the cir-
cumferential or rotational motion of the temporal bones

Temporal Wobble: Evaluation of Medial-Lateral Motion
Core Intent: To assess mobility of occipital-mastoid, and other temporal sutures. Can also be
used to re-synchronize motion after treatment if needed. (See Page 166)
Hand Placement: Bilateral, thumbs in contact with the lateral aspects of the mastoid processes,
head/occiput resting in the palms
Technique: Palpate symmetry, quality, amplitude and rate (SQAR) and synchrony of the medial-
lateral motion of the temporal bones

Occipital-Mastoid Release
Core Intent: To release restrictions in the occipital-mastoid suture and decompress the temporal
bones
Hand Placement: One hand posterior to the occiput, the occiput resting in the palm, finger pads
medial to the O-M suture, the other hand will gently grasp the cartilage of one ear. For the right
temporal bone the left hand will be on the occiput and the right hand will grasp the right ear. For
the left temporal bone the right hand will be on the occiput and the left hand will grasp the left ear.
Technique: The hand grasping the ear will provide very gentle traction in a posterior and lateral
direction while the hand on the occiput provides stabilization to the occiput. One temporal bone
is treated at a time so this technique will need to be repeated, changing the hand position from
one side to the other.
Figure I-10

Notes:

Temporal Ear Pull
Core Intent: Primarily to release restrictions in the horizontal membrane, the tentorium, in a pos-
terior-lateral direction. Will also address remaining sutural restrictions.
Hand Placement: Bilateral, gently grasp the cartilage of the ears, thumbs gently in the external
auditory meatus and fingers wrapped around the cartilage.
Technique: Provide gentle, bilateral traction in a posterior-lateral direction.
Figure I-11

Re-evaluation and Resynchronization
Repeat the evaluation of the circumferential and medial-lateral motion (See pages 161 &162)
Palpate the SQAR and the synchrony as before. If the right and left temporal bones are NOT in
synchrony then resynchronize by following the motion to the end of the range, hold one side at
the end of the range and wait for the other side to join it, then release the hold and follow the
motion for a couple of cycles (as instructed in class).

Temporal Ear Pull
Figure I-12

Addendum
The techniques given in this chapter are the keys to successful CranioSacral Therapy. They also
serve to distinguish CranioSacral Therapy from other forms of cranial manipulation. Perhaps the
most important aspect of CranioSacral Therapy is that of the cranial membranes. While other
techniques focus specifically on the osseous structures of the cranial system — the bones and sutural
connections — CranioSacral Therapy focuses on the Dural Membranes.
Successful correction of membranous restrictions enhances the overall mobility and compliance
of the Craniosacral System. Attention to membranous lesions can also prevent the need to correct
recurring sutural problems that arise when only the osseous structures of the cranium are treated.
Remember, you cannot release the membranes if the bones or sutures are restricted.
Finally, the structure of the cranial membranes dictate the most effective therapeutic approach. As
viscoelastic structures, the cranial membranes must be given time to adapt to the gentle, corrective
force of the practitioner. In applying the craniosacral techniques of this chapter, remember that
the Craniosacral System cannot be rushed. The most effective therapeutic approach is to introduce
a minimal corrective energy into the Craniosacral System. Then, one monitors the system over
time as it changes in response to this noncoercive force. This process is very educational for the
therapist as well as being therapeutic for the client.
SEE ILLUSTRATIONS OF ANATOMICAL DETAIL ON

FOLLOWING PAGES.

Lateral Cavernous Sinuses
Anterior Clinoid
(Process of Sphenoid)
Diaphragma Sella
Posterior Clinoid
Process (of Sphenoid)
Posterior Wall of Left
Cavernous Sinus Lateral Wall
of Cavernous
Lower Leaf of Sinus
Tentorium Cerebelli
Upper Leaf of
Tentorium
Cerebelli
Figure I-13
Crisscrossing lines represent Tentoriums and Dura of Diaphragma Sella and the Walls of the
Cavernous Sinuses.
This illustrates many possibilities for crisscrossing tensional forces within these tissues. Piercing
these tissues, and therefore vulnerable to the effects of these tensional forces, are numerous nerves,
vascular structures and the all-important Pituitary Gland. (See following diagrams.)

Notes:

Posterior View of Lateral Cavernous Sinuses
and Adjoining Structures
Anterior Clinoid
Processes
Subarachnoid space (CSF
filled and traversed by
numerous trabeculae)
Hypophysis (Pituitary)
Brain
Pia Mater
Cavernous
Sinus
filled with
Lateral wall blood and
of Sinus crisscrossed
(Meningeal with trabeculae
Layer of Dura (connecting
Mater) two layers
of Dura
Mater)
Endothelial Lining
inside Sinus —
encases nerves and Medial Wall of Sinus Body of Sphenoid Bone
separates them from (Endosteal Layer of
blood inside sinus Dura Mater)
Figure I-14

Notes:

Posterior View of Lateral Cavernous Sinuses and
Adjoining Structures (continued)
Oculomotor Nerve
Ophthalmic
Division of
Trochlear
Trigeminal
Nerve
Nerve
Maxillary
Division of
Trigeminal
Nerve
Abducent Nerve Internal Carotid Artery Carotid Sympathetic

Note — Carotid is within Nerve Plexus
the Sinus rather than
the lateral wall
Figure I-15

Notes:

THE TEMPOROMANDIBULAR JOINT
AND TEMPORAL BONES
Objectives:
1. To develop a basic working/functional comprehension of the anatomy of the

Temporomandibular Joint (TMJ).
2. To gain a clear understanding of the functional anatomy of the Temporal Bones.
3. To have a working concept of the interdependency between the TMJ and the
Temporal Bones and their function.
4. To have a working concept of the relationship between the Temporal Bones
and the rest of the Craniosacral System, including significant muscular attachments.
5. To evaluate and treat the TMJ.
6. To be able to instruct clients in self-help techniques for TMJ dysfunction.
TMJ and Temporal Bones 175

Temporomandibular Joint and Related Structures
Components that are significant to the CranioSacral Therapy practitioner:

Temporal Bone – fossa and eminence
Mandible – condyle
Intra-articular Disc
Retrodiscal Elastic Tissue
Lateral Pterygoid Muscle
Joint Capsule
Structures that influence TMJ function, not directly involved in the joint itself but which contribute
to dysfunction and may be favorably influenced by CranioSacral Therapy:
Temporalis Muscle
Sling Muscles (Masseter and Medial Pterygoid)
Stylomandibular Ligament
Hyoid Bone and its attached soft tissues
Teeth
Mandible
Coronoid Process
Axis of rotation in neck/angle
Trigeminal Nerve System
Reticular Activating System
Temporal Bone
All sutures
Zygomatic Process
Mastoid Process
Styloid Process
Notes: Temporalis Muscle and Attachment

Osseous Anatomy
Ear Canal
Zygomatic
Process
Articular
Tubercle
Tympanic part
of Temporal
Bone
Mastoid Process
Mandible
Mandibular Fossa
(Temporal Fossa)
Figure T-1

Notes:

Temporalis Muscle
Chronic Temporalis
Hypertonus can produce
compression of the
Articular Disc.
Figure T-2

Notes:

The Joint
General (Schematic) Anatomy of the Temporomandibular
Joint and its Relation to the Cranium
(For more detailed anatomy see the following page.)
Temporal Bone
Greater
Wing of Articular
Sphenoid Tubercle
(Temporal Fossa) Zygomatic
Mandibular Fossa Process
Ear Canal
Tympanic Lateral
Part of Pterygoid
Temporal Muscle
Bone
Mastoid Process
Pterygoid Process
of Sphenoid
Articular Disc
of the TMJ
Approximate Axis
of Rotation
Condylar Head
of Mandible Mandible
(Please note — Disc and space in fossa are exaggerated for purposes of illustration.)
Figure T-3

Notes:

The Joint
Posterior Temporal Roof of Mandibular

Attachment of Disc Fossa (Temporal Temporal Eminence of
(Retrodiscal Elastic Fossa) Articular Tubercle
Tissue)
Tendon of
Ear Attachment
Canal (Lateral Pterygoid
Muscle)
Posterior
Mandibular
Attachment
Posterior Anterior Capsule
Wall of
Capsule
Condyle of Mandible
Enlargement of Temporomandibular Joint

and its Components
Figure T-4

Notes:

Biomechanics of TMJ
1 2
Neutral
In initial stages of movement, mandible begins to

Closed Position swing around point on condyle (to open the jaw).
3 4
Mouth fully open

Axis of
Rotation
As movement progresses, condyle (A) slides

forward and down on disc (B), which slides
forward and down on temporal bone. Figure T-5

Notes:

TMJ Disc Dysfunction
This picture shows

how Mandible and/or
disc can “slip” past
Temporal Eminence —
“dislocating” jaw and/
or “catching” disc.
Hypertonic Pterygoid Muscle can pull the disc forward and hold it
there. Over time, this constant pull can alter the normally elastic
Retrodiscal Tissue so that it no longer has the tendency to pull
the disc back into the Temporal Fossa.
When disc remains

trapped in front of
Temporal Eminence and
Mandible returns to
closed position, Condyle
now rides on and compresses
Retrodiscal Tissue.
Figure T-6

Notes:

Muscles of
Mastication
Masseter Muscle
Lateral
Pterygoid
Muscle
Medial Pterygoid
Muscle
Temporalis
Muscle
Mylohyoid Muscle
Figure T-7
Hyoid Bone Sternohyoid Muscle

Notes:

Temporomandibular Joint Mechanics
Since the TMJ is anterior to the axis of rotation of the Temporal Bone (see illustration), we can
see how it is possible to lower or raise the position of the TMJ as we rotate the Temporal Bones
into External and Internal Rotation, respectively. A Temporal Bone located in the extreme end of
either external or internal rotation may cause the TMJ to be displaced and to ultimately become
dysfunctional. The Temporal techniques described below will ensure a proper mobility and position
for the Temporal Bone, and therefore contribute to improved TMJ function.
As you can see from the preceding illustrations of the TMJ with the mouth closed and open, the
Condyle of the Mandible moves in an anterior direction when the mouth is opened. When the
mouth is opened very far, the Mandible Condyle goes beyond the (inverted) peak of the Temporal
Eminence. Occasionally, if the slope is sharp and/or the peak angle is acute, when the Condyle
goes anterior to the peak it may “lock” there. When this happens, the individual’s mouth is stuck
wide open.
It is the responsibility of the Lateral Pterygoid muscle to move the disc forward at precisely the
correct rate of speed as the mouth is opened so that the disc is kept in an interposed position
between the Mandibular Condyle and the Temporal Bone. As the mouth is closed, the disc must
move posteriorly to maintain its correct position. This return of the disc to the posterior position
is the responsibility of the Retrodiscal Elastic Tissue. Failure of these tissues may allow the disc
to remain forward so that the Condyle of the Mandible slips off of the posterior edge of the disc.
When this happens, the Condyle begins to damage the elastic tissue by pressing on it. Thus, the
problem is perpetuated until the pressure can be taken off of the elastic tissue so that it can restore
its vitality (and thus its elasticity) toward normal.
CranioSacral TMJ techniques coupled with the self-help program can be quite helpful in the
restoration of the disc to its normal position between the Condyle and the Temporal Fossa.
Obviously, a reciprocal balance between the Lateral Pterygoid muscle and the Retrodiscal Elastic
Tissue is necessary for normal disc function.
A major factor in the production of too much compression on the disc and in the TMJ is a chronic
hypertonic condition of the Temporalis Muscle. This muscle, when it is contracted, shortens the
distance between the Mandible where it arises and the whole of the Temporal Fossa, which
includes the external vault surfaces of the Temporal, Parietal, Frontal and Sphenoid Bones. In so
doing, the Temporal Bone is pulled down and the Mandible is pulled up. This compresses the TMJ.
The Temporalis and the other muscles of mastication are all under the motor control of the Trigeminal
Nerve System. This system is closely integrated with the Reticular Alarm System, which is closely
related to anxiety, anger, stress, etc.
Therefore, it is easy to see how chronic hypertonicity of the Reticular Alarm System overactivates
the Trigeminal System, which in turn overactivates the muscles of the Masticatory System, especially
the Temporalis Muscle which, in turn, overcompresses the TMJ. Our objective, therefore, is to relax
the Reticular Alarm System in order to get the pressure upon the TMJ disc reduced to normal and
acceptable levels.

Temporomandibular Joint Evaluation and Balancing
Two-Phase Technique
(Reference CranioSacral Therapy, pp. 199-202)
Notes: TMJ Compression/Decompression
Core Intent: Compression — To engage “the unlatching principle” with the mandible
to release the soft tissue aspects of the TMJ.
Core Intent: Decompression — To further release the soft tissue of the TMJ and facili-
tate space and mobility.
Hand Placement (of both): Third and fourth fingers contacting entire ramus of the mandible
from the condylar head to the angle.

TMJ (Compression)
Figure T-8

Notes:
Decompress the mandible inferiorly,

then complete the traction by adding
a 10 degree anterior lift.

TMJ (Decompression)
Figure T-9

Self-Help Techniques
Notes: Fulcrum Technique

Self-Help With Fulcrum
Decompression
tractional force
Fulcrum for
Fulcrum decompression
Lever Gentle
manual
force
Light force directed in a

superior direction
Figure T-10

Notes: Manual Decompression Self-Help Techniques

Self-Help
Gentle traction to
decompress TMJ
Figure T-11

Notes:

Effect of Temporal Bone Dysfunction on the TMJ
Temporal
Bone Squamous
External Axis for

Rotation of
Temporal Bone
Figure T-12

Notes:

PROTOCOL FOR EVALUATION AND CARE
Objectives:
1. To develop highly sensitive palpatory skills.

2. To promote greater relaxation, as well as physical and mental function of your
patient/client.
3. To be able to apply the 10-Step Protocol in specific situations with expectations
of improved therapeutic response.
4. To be able to use your CranioSacral Therapy techniques while furthering your
academic knowledge of the Craniosacral System.
Protocol for Evaluation and Care 203

The 10-Step Protocol — Version 1
• Listening Stations (Heels, Dorsums, Thighs, ASISs, Ribs,
Shoulders, Three Vault Holds)
1. Still Point (CV-4, Sacrum, Feet, etc.)
2. Diaphragm Releases
a. Pelvic
b. Respiratory
c. Thoracic Inlet
d. Hyoid
e. Occipital Cranial Base
3. Frontal Lift
(Vertical Membrane System)
4. Parietal Lift (two parts)
5. Sphenobasilar Compression-Decompression
(Horizontal Membrane System)
6. Temporal Bone Techniques
a. Evaluation:
1. Circumferential motion, Finger in the Ear
2. Medial-lateral motion, Wobble
b. Treatment:
1. Occipital-Mastoid Release
2. Ear Pull
3. Re-evaluate and synchronize, if needed
7. Temporal Decompression (Ear Pull)
8. TMJ Compression and Decompression
9. Dural Tube Evaluation (Occiput/Sacrum, L5-S1 Decompression, Iliac Gap,
Rock/Glide)
10. CV-4/Still Point
V-Spread – Wherever Appropriate

The 10-Step Protocol — Version 2
• Listening Stations (Heels, Dorsums, Thighs, ASISs, Ribs,
Shoulders, Three Vault Holds)
1. Still Point (CV-4, Head, Sacrum, Feet, etc.)
2. Diaphragms:
a. Pelvic
b. Respiratory
c. Thoracic Inlet
d. Hyoid
e. Occipital Cranial Base
3. L5-S1 Decompression, Iliac Gap, Dural Tube Traction
4. Dural Tube Rock/Glide
5. Frontal Lift
6. Parietal Lift (two parts)
7. Sphenobasilar Compression-Decompression
8. Temporal Bone Techniques:
a. Evaluation:
1. Circumferential motion, Finger in the Ear
2. Medial-lateral motion, Wobble
b. Treatment:
1. Occipital-Mastoid Release
2. Ear Pull
3. Re-evaluate and synchronize, if needed
9. TMJ Compression and Decompression
10. CV-4/Still Point
V-Spread – Wherever Appropriate
• Listening Stations
* The sacral and dural tube steps have been changed from Version 1. The order of this protocol is
structured to free up restrictions that lie within the pelvic and spinal regions before commencing
to the head, which some practitioners may prefer.
Note: As you become skilled in the 10 evaluation and correction steps, you may wish to alter the
order to better suit your professional style. What is important to know is the specific procedures
and their applications. The order in which the procedures are applied varies among practi-
tioners. However, the two 10-Step Protocols presented above are recommended by Dr. Upledger
and are most commonly followed by Upledger Institute Certified CranioSacral Therapy Instructors.
Protocol for Evaluation and Care 205

After completion of the CranioSacral Therapy I workshop and adequate
practice (UI recommends 75-100 10-Step Protocols), you will be ready to
further your studies with our next workshop, CranioSacral Therapy II.
CRANIOSACRAL THERAPY II
❏ CranioSacral Therapy for TMJ Syndrome and Hard Palate Dysfunction
❏ CranioSacral Therapy for Infants and Children
❏ SomatoEmotional Release ® and Energy Cysts
To participate in this workshop you must complete the CranioSacral Therapy I course.
Advance Preparation: Chapters 7-15 of CranioSacral Therapy by John

Upledger, D.O.,O.M.M., and Jon D. Vredevoogd,
M.F.A., and CranioSacral Therapy II, Beyond
the Dura by John Upledger, D.O. O.M.M. (Pay
particular attention to Chapter 3.)

BIBLIOGRAPHY
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Doidge, N. The Brain That Changes Itself: Stories of Personal Triumph From the Frontiers of
Brain Science. James Silberman Books, 2007.
Nelson KE, Sergueef N, Glonek T, “Recording the Rate of the Cranial Rhythmic Impulse.” The
Journal of the American Osteopathic Association (2006)106(6):337-341.
Umphred, DA. Neurological Rehabilitation. Edinburgh: Elsevier Mosby, 2006.
Gilchrist, R. Craniosacral Therapy and the Energetic Body: An Overview of Craniosacral
Biodynamics. Berkeley, Calif: North Atlantic Books, 2006.
Kern, M. Wisdom in the Body: The Craniosacral Approach to Essential Health. Murrieta, Calif:
Pacific Distributing, 2005.
Upledger Institute. Working Wonders: Changing Lives with Craniosacral Therapy: Case Studies
from Practitioners of CST. Berkeley, Calif: North Atlantic Books, 2005.
Upledger, L. “CranioSacral Therapy Releases Hold on Subluxations.” The American
Chiropractor. (2005)27.13: 56-57.
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Rehabilitation. St. Louis: Mosby, (2001): 980-81.
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Rehabilitation. St. Louis: Mosby, (2001): 965-66.
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Osteopathic Manipulative Medicine. SFIMMS series in neuromusculoskeletal medicine.
San Francisco CA: SFIMMS Press, 2000.
Upledger, JE. The Discovery and Practice of Craniosacral Therapy Berkeley, Calif: North
Atlantic Books, 2000.
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Upledger, JE. “Connective tissue perspectives: Craniosacral Therapy.” Journal of Bodywork
and Movement Therapies. (2000)4.4: 286-287.
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Medicine and Health Sciences, 2000.
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Upledger, JE, Vredevoogd, JD. CranioSacral Therapy, Eastland Press, 1983

CRANIOSACRAL THERAPY CURRICULUM
FLOW CHART
Sensory CranioSacral CranioSacral

Therapy & the Therapy & the
Integration for Digestive & Cardiac &
CranioSacral Gastro-intestinal Pulmonary
Therapists Systems Systems
(SICS) (CDGS) (CCPS)
CranioSacral Unwinding
Therapy Meridians:
Techniques Applying
Acupuncture
Certification Principles to
(CACST) CST (UMAC)
*DATE & BAER CranioSacral

prerequisites are Therapy
SERI & one of for
the following: * * Pediatrics 1
BAES or BAEA. (CSP1)
CranioSacral
Therapy
for
Pediatrics 2
(CSP2)
BioAquatic
Exploration,
SomatoEmotional
Release® II BioAquatic *BADA
(BAES)* Advanced prerequisites are
SERII & one of
& Dolphins the following:
Exploration* BAES, BAEA
(BADA) or BAER.
Clinical BioAquatic Clinical

CST and the Application of CranioSacral Exploration,
Therapy Application of
Reversal of Advanced Advanced Advanced
Pathogenic CranioSacral Diplomate CranioSacral
Certification CranioSacral
Processes Therapy Therapy* Therapy for
(CSRP) (CAAD) (CACSD) (BAEA) Pediatrics
(CAAP)
Appendix A-1
THE UPLEDGER INSTITUTE AND
ITS EDUCATIONAL CURRICULUMS
Continuing Education and Complementary Care
The Upledger Institute (UI) is a health resource center dedicated to the advancement of innovative
techniques that complement conventional care. It’s recognized worldwide for its groundbreaking
continuing-education programs, clinical research and therapeutic services.
Founded in 1985 by John E. Upledger, DO, OMM, UI has trained more than 80,000 practitioners
worldwide in CranioSacral Therapy and other gentle healthcare modalities. Today it conducts
hundreds of workshops each year educating healthcare professionals of diverse disciplines.
The cornerstone of our educational training is CranioSacral Therapy, a gentle, hands-on, whole-body
method of releasing restrictions around the brain and spinal cord to enhance central nervous system
performance and allow the body to self-correct.
Developed by Dr. John E. Upledger after eight years of clinical research and testing at Michigan
State University, CranioSacral Therapy has proven effective in aiding individuals with a wide range
of medical challenges, including migraines, neck and back pain, fibromyalgia, chronic fatigue, TMJ
syndrome, motor-coordination impairments, autism, central nervous system disorders, colic, learning
disabilities, brain and spinal cord injuries, emotional difficulties, stress-related problems, neuro-
vascular or immune disorders, post-traumatic stress disorder and post-surgical dysfunction.
Just as with CranioSacral Therapy, every modality practiced or taught through UI is designed to
relieve health problems at their source to offer a wealth of benefits, from pain relief to whole-body
wellness. And because each UI course curriculum is personally designed by its modality developer,
your education comes straight from the source.
A-2 Appendix
CranioSacral Therapy
Developed by John E. Upledger, DO, OMM
CranioSacral Therapy (CST) is a gentle, light-touch method of evaluating and enhancing the cranio-
sacral system, the environment in which the brain and spinal cord function. An imbalance or
dysfunction in the craniosacral system can cause sensory, motor or neurological disabilities. These
problems may include chronic pain, eye difficulties, scoliosis, motor-coordination impairments and
learning disabilities, as well as other physical and psychological problems.
The CranioSacral Therapy curriculum begins with the entry-level workshop CranioSacral Therapy I,
which provides the critical foundation necessary to understand the functioning of the craniosacral
system. Using palpatory skills to detect subtle biological movements, and fascial and soft-tissue
release techniques in a 10-Step Protocol, participants learn to evaluate and work with the entire
body.
CranioSacral Therapy Certification

The Upledger Institute offers certification in CranioSacral Therapy at two levels: a CST Techniques
certification for those who have completed CSII, and a more advanced Diplomate level for Advanced
CST alumni. Examination for certification at each level is a multi-tasked project including written,
oral and hands-on testing.
CranioSacral Therapy Courses

• CranioSacral Therapy I • The Brain Speakssm • Advanced Preceptorship
• CranioSacral Therapy II • CranioSacral Therapy • Advanced II Preceptorship
• Unwinding Meridians: Applying for Pediatrics 1
sm
• CranioSacral Techniques for
Acupuncture Principles to • CranioSacral Therapy Estheticians
CranioSacral Therapy for Pediatricssm 2
• ShareCare®
• Clinical Application of • CranioSacral Therapy and
• Clinical Application of Cranio-
CranioSacral Therapy the Immune Response
Sacral and SomatoEmotional
• CranioSacral Dissection • CranioSacral Applications to
• Therapeutic Imagery & Obstetrics I Release for Pediatrics
Dialoguesm I • Advanced I CranioSacral Therapy • CranioSacral Therapy and the
• SomatoEmotional Release ® I • Clinical Application of Reversal of Pathogenic Processes
• Clinical Application of Advanced CranioSacral Therapy • Clinical Application of Advanced
SomatoEmotional Release • BioAquatic Explorations CranioSacral Therapy for
• SomatoEmotional Release ® II • Advanced II CranioSacral Therapy Pediatrics
Appendix A-3
THE
UPLEDGER ®
A member of
INSTITUTE, INC.
INTERNATIONAL ALLIANCE OF HEALTHCARE EDUCATORS (IAHE)
The International Alliance of Healthcare Educators (IAHE) is a cooperative of Continuing
Education providers who offer other workshops in alternative healthcare modalities.
The current modalities available through IAHE include:
• CranioSacral Therapy/ SomatoEmotional Release
John E. Upledger, DO, OMM
• Visceral Manipulation
Jean-Pierre Barral, DO, MRO(F), PT
• Neural Manipulation/Manual Articular Approach
Jean-Pierre Barral, DO, MRO(F), PT
& Alain Croibier, DO, MRO(F)
• Healing From the Core
Suzanne Scurlock-Durana, CMT, CST-D
• Therapeutic Systems
Kerry D’Ambrogio, DOM, AP, BSc, PT
• Equine CranioSacral Therapy
Gail Wetzler, RPT, CVMI, BI-D, EDO
• NeuroMuscular Therapy
Judith (Walker) Delany, LMT
• Mechanical Link
Paul Chauffour, DO
• Zero Balancing
Fritz Smith, MD
• Process Acupressure
Aminah Raheem, PhD
All courses listed are intended to be taught as

• The Feldenkrais Method
modalities for licensed healthcare professionals.

Ann Harman, DO
Some courses may require prerequisite training.
• Qigong T’chings
The International Alliance of Healthcare Educators®

Cloe S. Couturier LMT/CO, CST-D
• Website: www.iahe.com
• E-mail: iahe@iahe.com
Find a Practitioner:
International Association of Healthcare Practitioners®
• Website: www.iahp.com
• E-mail: iahp@iahp.com
The Upledger Institute, Inc.®
• Website: www.upledger.com
• E-mail: upledger@upledger.com
A-4 Appendix
SUBMITTING YOUR NEWS RELEASE TO
LOCAL PUBLICATIONS
• Type the news release sample from the following page onto your letterhead, filling in the
blanks as indicated. Be sure to include your name and a telephone number where you
can be reached during business hours.
• Develop a mailing list of publications — daily and weekly newspapers as well as local
magazines. Telephone these sources and ask for the name of the news editor. Your press
release should be addressed by name to these individuals at their respective media outlets.
• Don’t forget to mail releases to any local professional organizations that publish newsletters,
as well as to your school if you studied locally. Be sure to mention that you are an alumnus
of that school.
• Include a 5x7 black and white photograph, if available, with your release. Be sure to put
your name on the back and include a sturdy piece of cardboard in the envelope to keep the
photograph from bending. It’s a good idea to print “Do Not Bend” on the envelope, too.
Photographs often will not be returned.
Appendix A-5
SAMPLE
News Release
FOR IMMEDIATE RELEASE: CONTACT:

(insert today’s date) (Your name, phone number, e-mail address)
THERAPIST BRINGS ENERGIZING NEW TECHNIQUES TO

[INSERT YOUR HOMETOWN]
[YOUR CITY, state] — [Your name and professional title] recently participated in the CranioSacral
Therapy 1 workshop offered by The Upledger Institute, Inc., an innovative organization that offers
continuing education courses to healthcare professionals worldwide.
The course is designed by osteopathic physician John E. Upledger, who developed CranioSacral
Therapy and has taught the technique internationally.
CranioSacral Therapy is used to detect and correct imbalances in the craniosacral system, which may
be the cause of sensory, motor or neurological dysfunction. The craniosacral system consists of the
membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. It extends
from the bones of the skull, face and mouth — which make up the cranium — down to the sacrum,
or tailbone area.
The therapy has been successfully used to treat headaches, neck and back pain, TMJ, chronic fatigue,
motor coordination difficulties, eye problems and central nervous system disorders.
For information on CranioSacral Therapy or The Upledger Institute at 1-800-233-5880.
###
A-6 Appendix
MODEL FOR RESEARCH CASE STUDY
OR SINGLE-SUBJECT DESIGN
Introduction
Following are suggestions for a simple yet concise research case study or single-subject design. You
can utilize sections 5 and 7 to expand on philosophy or constructs. Sections may even be omitted as
appropriate. When most of this information is incorporated on an intake evaluation and discharge form,
then only minimal effort is needed to make a publishable single subject design or case study format.
The submitted report will:
• Support the effectiveness of the therapy that was used in the study.
• Open opportunities to validate concepts and techniques within various professional forums.
• Reinforce the depth of your knowledge and skill as a published practitioner.
Report Format
A report could be divided into the following sections:
1. Introduction: What is the problem/diagnosis?
2. Review of Literature: Past medical history, etiology of the problem, date of onset, social history,
previous treatment including surgeries for this problem (and results), and any diagnostics done.
3. Procedure/Treatment: Include all treatment procedures, modalities, exercise (home and office)
treatment time per session, plus total treatment span (including frequency). If modalities were
used, be specific as to any particulars. Mention specific treatment positions if appropriate for
further classification.
4. Outcomes/Analysis of Results: Both functional and structural outcomes should be listed here,
i.e., pre- and post-tests if applicable. (Try to get 2-3 measurements each pre-and post-test as it
improves reliability and validity of treatment.) Measure outcomes functionally, also. (Most
clinics/practitioners are obtaining this information from patients as well as the “objective” data.)
Include patient’s self-assessment as well as therapist’s patient assessment. Rate a percentage
of improvement (usually a scalar measurement).
5. Discussion: What do your findings mean? How do they add to the established body of knowledge?
Where do you go with your results? Make recommendations for change for further analysis of
the same subject.
6. Summary: An abstract.Summarize points 1-4 (for potential publication).
7. Conclusions and Recommendations for Further Study: Was the treatment successful? If so,
how did you measure success? If not, what would you do differently with this individual?
8. Appendices: May include subject consent form (if appropriate), technical data, date of birth, treat-
ment dates. (If no-name submission, use an identification process other that abbreviations or initials.)
9. References: If appropriate or beneficial for further research. Format as:
1. Kidder, L. & Judd, C., Research Methods in Social Relations, Holt, Penihart & Winston,
Inc. 5th Edition, New York, NY 1978.
2. McEwen, Irene, Writing Case Reports: A How-To Manual for Clinicians. APTA Pub.,
Alexandria, VA. 1996.
Appendix A-7
UI-Approved Study Groups
Following the completion of your class, you will be eligible to participate in an Upledger Institute-
sanctioned study group that corresponds to the coursework you studied. Study groups offer a
small-group environment where you can network, reinforce your skills and discuss case histories
with similarly trained colleagues.
Study-group leaders may charge members a nominal fee; these generally range from $5-$10 per
meeting.
To locate a study group in your area:

• See your class facilitator. A list of active study groups is available at the product tables
at all workshops.
• Call Educational Services at 1-800-233-5880.
• Log on www.upledger.com. Go to “work with us” and click on the “study groups” tab
on the left or cut and paste this url www.upledger.com/content.asp?id=16 into your
web browser.
“Study groups are worth their weight in gold. They build practitioners’ confidence and help them
remember the technical details. They’re invaluable in terms of providing good, guided practice time.
And practice is what really makes a good practitioner into an excellent one.”
— Suzanne Scurlock-Durana, CMT, CST-D
A-8 Appendix

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CranioSacral

Date of Seminar ____________________________________________

Location of Seminar ________________________________________

John E. Upledger, DO, OMM

All rights reserved.

No part of this study guide may be reproduced or

For additional copies of this study guide, please call

THE UPLEDGER INSTITUTE, INC.

Insurance reimbursement policies vary for manual therapies. If insurance reimbursement is an

• Explore the history, principles and neuromuscular basis of

• Learn to conduct a thorough evaluation using the craniosacral rhythm

• Formulate therapy strategies.

• Perform CranioSacral Therapy techniques to help normalize common

— Dr. John Upledger

1. Efficiency Factor — Knowledge

2. Paradigm (i.e., frame of reference)

3. Belief System (i.e., frame of reference based on a feeling of certainty)

“Remember, as long as you believe something, your brain operates on auto-

Fascia and Diaphragms ................................................................................................23

Occipital Cranial Base and Lumbosacral Decompression ........................................53

Semi-Closed Hydraulic Craniosacral System ............................................................91

Still-Point Induction ....................................................................................................113

Intracranial Membrane System ................................................................................137

Temporomandibular Joint and Temporal Bones......................................................175

Protocol for Evaluation and Care ..............................................................................203

CranioSacral Therapy Curriculum Flow Chart ......................................................A-1

The Upledger Institute and Its Educational Curriculums ......................................A-2

International Alliance of Healthcare Educators® Curriculums ..............................A-4

Submitting Your News Release ..................................................................................A-5

Model for Research Case Study or Single-Subject Design......................................A-7

UI-Approved Study Groups ......................................................................................A-8

The Craniosacral System is a recently discovered physiological system. It is a semi-closed

1. To develop an appreciation of palpation potential.

1. To develop an appreciation of the total-body fascial system and its transverse

Fascia and Diaphragms 23

Fascia and Diaphragms 25

Any change in the tissue can be considered a sign of release.

Fascia and Diaphragms 27

Levator Ani Muscle

Fascia and Diaphragms 29

Schematic Diagram of the Male Pelvis

Loose Endopelvic Fascia

Fascia and Diaphragms 31

Hand Placement: Posterior hand — Transverse under L5-S1 and sacrum.

Fascia and Diaphragms 33

Fascia and Diaphragms 35

Muscular Part of Diaphragm Xiphoid Process

Left Psoas Major

Fascia and Diaphragms 37

Fascia and Diaphragms 39

Hand Placement: Posterior hand — Transverse under T12-L1.

Lateral View of Diaphragm Release

Fascia and Diaphragms 41

Fascia and Diaphragms 43

Of interest are the many divergent

Fascia and Diaphragms 45

Picture on right shows major veins and

Fascia and Diaphragms 47

Hand Placement: Posterior hand — Transverse under C7-T1.

Fascia and Diaphragms 49

Fascia and Diaphragms 51

1. To gain appreciation of the anatomical complexity and vulnerability of the

Occipital Cranial Base 53

Occipital Cranial Base 55