Craniosacral Therapy
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Laurance Johnston, Ph.D.

Craniosacral therapy is a gentle hands-on alternative medicine procedure for evaluating and enhancing the functioning of the craniosacral system, a physiological system surrounding the brain and spinal cord. 

Therapy advocates believe that this system influences the whole body by affecting the brain and spinal cord, as well as the brain’s pituitary and pineal gland. As such, the craniosacral system serves as a core function in that the entire body’s health depends on its well being. As a core function, the therapy has the ability to treat a wide-range of disorders and physical disability, including spinal cord injury ( SCI).


Craniosacral therapy evolved from osteopathic medicine with its mJohn Upledger and craniosacral therapy for spinal cord injury (SCI)usculoskeletal emphasis. In the early 1900s, osteopathic physician William Sutherland concluded that skull bones are not firmly fixed but can move relative to each other. With these observations, he developed a treatment called cranial osteo. In recent years, Dr. John Uplefurther developed Sutherland’s observations and incorporated them into a treatment now called craniosacral therapy. 

Dr. Upledger’s interest was whetted early in his career. While assisting a neurosurgeon in the removal of plaque from a patient’s spinal cord membrane, Upledger observed the membrane pulsating in spite of his best efforts to keep it still. This was his first observation of the craniosacral rhythm. He later researched this phenomenon for eight years as a professor of biomechanics at Michigan State University (East Lansing). To more effectively transfer his research findings to consumers, in 1985, he established the Upledger Institute in Palm Beach Gardens, Fla. Since then, more than 38,000 practitioners have been trained in craniosacral therapy, including osteopaths, medical doctors, chiropractors, psychologists, dentists, physical therapists, acupuncturists, and massage therapists.

The Craniosacral System:

The spinal cord is surrounded by a protective, three-layered membrane system (the meninges) that lies within the vertebral column. The outside layer is called the dura mater; the middle layer the arachnoid membrane; and the innermost layer the pia mater. The inside layer is tightly attached to the spinal cord, while cerebrospinal fluid is between the other sections.  In addition to providing nutrients, the lubricating cerebrospinal fluid allows the membrane layers to glide in relationship to one another as the spine bends and twists. The tough dura mater protects everything inside of it, including the brain and spinal cord.

The craniosacral system consists of this membrane system, the enclosed cerebrospinal fluid, the physiological structures that control fluid input and outflow, and related bones. Craniosacral System and spinal cord injury (SCI)It is a semi-enclosed biological hydraulic system encompassing the brain and spinal cord. Within the system, the cerebrospinal fluid rhythmically pulses at a rate of about ten cycles per minute. This is independent of heart or respiratory rhythms.

The craniosacral system’s fluid barrier is the dura mater, which also composes the skull’s inside lining. Dr. Upledger’s research indicates that the skull bones must be slightly moving continuously to accommodate the fluid pressure changes within this semi-closed hydraulic system. The membrane barrier is also attached to the upper neck vertebrae, the lower back sacrum, the tailbone, and the openings in the spinal column where nerves go out to the body.

Any occurrence that interferes with the membrane’s ability to accommodate the rhythmically fluctuating fluid pressures and volumes is a potential problem.

Craniosacral therapy’s object is to find areas of restricted movement that compromise function and re-establish normal movement. Because the craniosacral system encloses the brain and spinal cord, it influences the entire nervous system, affecting many body functions.  These include the brain’s important pituitary and pineal glands. These glands, in turn, have the potential to affect the body’s entire hormonal balance.

The Controversy:

Mainstream medicine has criticized craniosacral therapy, sometimes vociferously, primarily because the underlying theory challenges many classical anatomical assumptions. For example, Dr. Stephen Barrett (, an outspoken alternative medicinet critic, says  “the theory behind craniosacral therapy is erroneous because the bones of the skull fuse during infancy and cerebrospinal fluid does not have a palpable rhythm.” 

Dr. Rosenfeld’s Guide to Alternative Medicine echoes the former concern. However, this dogma is not universally accepted. In parts of Europe, for example, it is taught that the skull bones do, indeed, have movement potential.

Dr. Upledger feels that the axiom about fused skull bones may have come from the routine practice of using for anatomical examinations, long-time-after-death cadavers treated with preservative chemicals. He says that fresh, unpreserved sutures (the skull bone edges) are full of dynamic tissue, nerves, and blood vessels, consistent with a flexible system allowing some movement.  In contrast, the sutures from old preserved skulls appear calcified.

Dr. Upledger says most neurosurgeons have not observed the craniosacral rhythm because most surgery penetrates the membrane barrier required to maintain the rhythm.  In his guide, Dr. Rosenfeld basically agrees, noting “Unfortunately, none of my colleagues… among others, some very good neurologists - has ever seen, touched or had any other contact with cerebrospinal fluid except after withdrawing it for analysis.”

A Hands-on Process:

During craniosacral therapy, trained therapists use a light touch equivalent to a nickel’s weight, and feel the rhythmic motion of the cerebrospinal fluid within the craniosacral system. Therapists check the rate, amplitude, symmetry, and quality of this wave-like motion in places where the craniosacral membrane barrier attaches to bones such as the skull, sacrum and tailbone. Any restrictions or blockages are treated with light-touch adjustments.

A restriction in one part of the craniosacral system can affect the entire system, so treatment may involve working at a point distant from the overt symptom. By assisting the hydraulic forces in the craniosacral system and, in turn, improving central nervous system (CNS) functioning, treatment facilitates the body’s innate, self-healing mechanisms.

Spinal Cord Dysfunction:

The Upledger Institute’s Brain and Spinal Cord Dysfunction Program treats about 120 people each year. Most reportedly have some improvement, ranging from modest to fairly dramatic. Change takes place with motor function, bowel and bladder control, spasticity management, and overall well being and ease.  Because patients are usually at least 2-3 years post injury, improvement is not attributed to residual, ongoing functional improvement often observed in the first year after spinal cord injury.  

The facility customizes the intensive, two-week program to the person. It may include a variety of additional hands-on therapies, such as massage, acupuncture, and a craniosacral-related therapy called somatoemotional release. In part, these procedures are designed to help muscles that are spastic, injured, hypertonic or unused; they also help energy flow and balance. Individuals are usually treated once a year, often with some follow-up therapy at home. Each day starts with a group discussion that includes patients and therapists, followed by two hours of hands-on therapy in the morning and afternoon.

As in the case of many health-care professionals using substantial hands-on, bodywork, experienced craniosacral therapists feel as if they can “read” the body.  For example, they can localize the level of injury without other information. Furthermore, they often note the presence of secondary and tertiary injury sites resulting from the mechanics and vector forces of impact. A C-4 quadriplegic, for example, may have experienced secondary trauma at the T-5 level.

Dr. Upledger says initial trauma results in edema. A burst of cerebrospinal fluid results in tissue separation that heals with fibrous scarring. “It is like a copper wire after being hit with a hammer; it won’t conduct as well,” he says.

Because this secondary damage occurs relatively soon after injury, Upledger believes that to get fluids moving, patients should receive treatment within the first month after injuries. Unfortunately, under the current standards of medical care, access to craniosacral therapy would be unlikely.

Jackie, who has received therapy in the program, was injured in a 1990 car accident and is an incomplete quadriplegic. He has been treated several times at the facility beginning last year and emphatically states that “they have helped me more than anyone ever has before.  I now have much more feeling and muscle control.” Jackie now walks without the full leg brace that was previously needed.

He is a man that likes to “work hard and play hard,” and his improved trunk muscles, critical for balance, allow him to use a three-wheel motorcycle once again. He distinctly remembers the moment on the therapy table that he first regained some feeling in his left hip.  “The tingle felt like the sensation when you try to move a leg that has gone to sleep.” Jackie says patients and staff develop tremendous rapport.  “They are like your next-door neighbors.”

As is the case for many treatments, alternative and mainstream, scientifically rigorous clinical studies have not supported craniosacral therapy for spinal cord injury and dysfunction.. Although results appear promising, they are still only anecdotal. However, given the growing base of these anecdotal results and evidence supporting the existence of a craniosacral system, the therapy’s potential appears promising for many.

Contact:  The Upledger Institute at 561/622-4334 or

Adapted from an article appearing in the November 1998 issue of Paraplegia News (For subscriptions, contact

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