Cranial Osteopathy 04/17/2007 10:30 PM

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Cranial Osteopathy
• Other articles on Bodywork

by Joseph Goodman
To understand cranial
osteopathy it is necessary to
understand osteopathy itself.
As with visceral osteopathy,
the term refers to an aspect of
osteopathy, not to a separate
modality.
Given that osteopathy is
about to be confirmed as a
statutorily self-regulated
profession in the United
Kingdom it is opportune to
refer back to its origins in the
last half of the 19th century.

About the Author

Joseph Goodman is a
naturopath, osteopath and
acupuncturist practising in
London. He is Head of
Department of Theory and Saggital Section: Head & Neck
Practice of Osteopathy at the
College of Osteopaths where
To understand cranial osteopathy it is necessary to understand
he is also senior lecturer in the
principles and philosophy of osteopathy itself. As with visceral osteopathy, the term refers to an aspect
naturopathy. of osteopathy, not to a separate modality.
Given that osteopathy is about to be confirmed as a statutorily self-
regulated profession in the United Kingdom it is opportune to refer back to
its origins in the last half of the 19th century. Andrew Taylor Still, born in
Virginia in 1828, engineer and then army surgeon during the American
Civil War, became dispirited with the medical shortcomings of his day
with its indiscriminate drugging and brutal surgery.(1) Spurred on, no
doubt, by the deaths of his three children from 'spinal meningitis' he felt
impelled to find more compassionate ways of dealing with medical
problems. Osteopathy was the result.
In his book written in old age (2) at the turn of the century, Still
describes osteopathy as "a scientific knowledge of anatomy and
physiology in the hands of a person of intelligence and skill who can
apply that knowledge to the use of people who are sick or wounded by
strains, shocks, falls or mechanical derangement or injury of any kind to
the body." Such a practitioner sees the potential for disease in the slightest
anatomical deviation. A successful osteopath is or should be a "person of

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Cranial Osteopathy 04/17/2007 10:30 PM

individuality with a mechanical eye behind all motions or efforts to

readjust any part of the body to its original normality." Well-directed skill
is essential rather than unguided force in giving relief.
Still goes on to describe the role in health and disease of essential
tissue such as nerves, blood and lymph vessels, cerebrospinal fluid (CSF,
he proclaims, is the highest known element in the human body – "a great
river of life that must be tapped and the withering field irrigated at once or
the harvest of health is forever lost'), fascia, the brain and spinal cord, the
viscera (body organs] and the other fluids of the body. On page 46 he
gives some cautionary advice: "Many of your patients are well six months
before they are discharged. They continue treatments because they are
weak and they are weak because you keep them so by irritating the spinal
cord."
"Throw off your goggles," says Still, "and receive the rays of sunlight
which forever stand in the bosom of Reason."
In appropriate context, throwing off the goggles seemed to reveal fertile
ground for innovation. Chief amongst Still's disciples was William Garner
Sutherland (3) who, 60 years ago, set out to demonstrate that, contrary to
current belief, motion was possible and indeed existed in the sutures of the
skull. He showed that there was at the same time a persistent involuntary
movement of the tissues and organs such as the brain and spinal cord, the
sacrum between the ilia [pelvic bones] and the trunk and limbs. He termed
the whole process the Primary Respiratory Mechanism (PRM) – primary
because he rated its significance to the onset of and departure from life
above that of the heart or lungs.
The rate of movement of the PRM he called the cranial rhythmic
impulse (CRI), a rhythm distinct from that of the other two. The CRI and
the palpable movements of the body and of the CSF became of diagnostic
and therapeutic importance in the total osteopathic approach to an
individual. Sutherland's teachings were effectively presented by Harold
Magoun in the first ever textbook for practitioners, (4) since when there
have been numerous others. Among the most research-based are those of
M.B. De Jarnette (5) and John Upledger. (6)
Why, then, the emphasis on cranial osteopathy as if it might supersede
osteopathy, as if an arm and a leg (to be exact a head and a sacrum) were
to become the body itself? Part of the trend is justified. Because of
Sutherland and others some of the teachings of Still have been elaborated
upon, made more of. To quote from Kimberly (7) "without the teachings
of Sutherland at least one third of the autonomic system and two thirds of
the central nervous system are being neglected in the consideration of the
patient as an osteopathic whole." Made more of is the key phrase. Cranial
osteopathy is not and should not be thought of as an exclusive, specialised
programme of health care. Even less should there be a temptation to
consider cranial osteopathy as a cure-all, however effective it is in many
instances.

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Sphenoid and occiput

Sutural bevels to guide movement of bones

Sutherland's researches (8) are at the root of a variety of training

programmes such as Sacro-Occipital Technic, Craniosacral Therapy,
Craniopathy and Sutherland Osteopathy with its newly-titled concept of
the Involuntary Mechanism. Students include masseurs, reflexologists,
aromatherapists, kinesiologists and acupuncturists as well as osteopaths
and chiropractors. From the orthodox professions come podiatrists,
physiotherapists, dentists, midwives, medical doctors and nurses. In truth,
there is no health care professional who would not benefit from some
instruction in the cranial concept – it appears no longer to be the preserve
of the osteopath. The last sentence reflects a much debated issue at
present, something for the correspondence pages of this journal perhaps.
Individuals proceed through life by unveiling aspects of themselves as
they mature. I doubt that they end up with characteristics additional to
those with which they were born. In the same way, osteopathy as
conceived by Still yields up facets of its inner truths with every new
worker in the field. Sutherland was osteopathy's facet developer of
inspired and painstaking quality. His product deserves the title cranial
osteopathy. On a parallel course ran the lifetime of research that osteopath

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M.B. De Jarnette (9) developed for the chiropractic profession.

Every function depends upon an impulse generated in some part of the
brain. If no impulse is generated the spinal cord has nothing to carry to any
destination in the body. Whatever is best in therapeutics whether "cranial",
surgical, medical or complementary is only as efficient as the cranium and
its contents. The brain makes recovery possible. The message has to be
developed before it can be delivered. The brain creates the message, the
spinal cord delivers it and the pelvis (including the sacrum) must be in
balance before any component can function efficiently.
Cranial osteopathy is not aggressive. It does not try to move the
immovable. It is a gentle process of letting the respiratory system move the
membranes of the internal cranial vault. Eight cranial and fourteen facial
bones must articulate with each other so that all work together in harmony.
Sutures (where cranial bones join each other) tie the cranial vault together
and are lined by the tension membranes. Left and right membranes must
be equal or at least they must synchronise with each other. All structures
must be supplied with blood. Drainage systems must be kept open and
draining. Lymph vessels must carry the products of metabolism
unhindered from abdomen and chest to the heart. Mandibular articulation
(the TMJ: temperomandibular joint) must be aligned for chewing food.
The brain is the controller and with the hormonal system the coordinator
of all such activities.
"Much energy," says De Jarnette, "is wasted by manipulators trying to
make a vertebra replace the human brain." This is partly a reference to the
limited approach of those osteopaths who do not include in their analyses
the influence as well as the vulnerability of the cranial nerves within the
skull. Cranial and sacral nerves are primarily parasympathetic autonomic
controllers of all the senses, the movements of vital organs and the
secretions of glands both endocrine and exocrine. There is more, therefore,
to restoration of function than the adjustment of vertebrae, unless it is
considered that the sphenoid bone which lies in the middle of the head is
the uppermost vertebra of all.
The sphenoid is a shapely bone, not unlike a huge butterfly or moth and
it articulates with the occiput at what is known as the sphenobasilar
symphysis (sbs). Almost every bone in the head has a sutural junction
with the sphenoid confirming the key role that the sphenoid plays in the
integrity of the cranium. A blow anywhere on the head or face, a wisdom
tooth pulled inexpertly, an unequal bite are examples of the ways in which
the cranial bones and therefore their attached membranes can be distorted.
Distortion can result in interference with any of the cranial nerves in the
head and because of the fascial connection between occiput and sacrum
there can be disturbances in the influence of sacral nerves as well.
The problem can be induced in the reverse direction almost as easily. A
fall on the coccyx or a pelvic distortion because of a difference in leg
lengths can malposition the sacrum within the iliac bones which in turn
could offset the occiput and there onwards the sphenoid, the temporal or
the parietal bones. If uncorrected, other cranial bones such as the frontal,

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Cranial Osteopathy 04/17/2007 10:30 PM

zygomatic or maxillary can be affected. In time, cranial nerves can be

disturbed as they pass through foramina (holes) in some of the bones and
drainage from venous sinuses, such as that running along the inner surface
of the parietal sagittal suture, can be impaired.
90+% of all blood from the head is drained through vessels that pass
through the jugular foramen, a space between the temporal and occipital
bones. Through the same foramen pass three cranial nerves, the
Glossopharyngeal (IX), the Vagus (X) and the Spinal Accessory (XI). It is
the Vagus that controls the sensations, activities and proprioception of
many of the body's organs affecting breathing, circulation and digestion,
while the other two influence such factors as taste, the ability to swallow,
and the power to shrug the shoulders. Any of those functions can be
affected, grossly or subtly, if the foramen is so disturbed by trauma or
disease that the nerves and blood vessels that pass through it are
compromised (see figure 3).

Figure 3 (Below) The hazards of being a nerve

Cranial osteopathy, then, is a structure-based system of medicine that

calls into account all aspects of living, both causative and consequential.
The primary respiratory mechanism is initiated at birth when the emergent
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Cranial Osteopathy 04/17/2007 10:30 PM

baby becomes independent of mother's umbilical nourishment. It starts

with an intake of breath followed by an out breath that is the listened-for
first cry of the baby. The PRM ends its activities with a final breath out,
hopefully a good number of years later.
None of the five components of the PRM shown in fig 1 exists on its
own. It is the package as a whole that the sensitive practitioner is obliged
to tune into. Figures 2 and 4 suggest that reasons for distress can stem
from any system of the body, each in turn subject to external factors such
as poor nutrition, polluted air, mento-emotional stresses and other
influences that call for attention concurrently with hands-on treatment.

Fig 1 (Below) Phenomena od the Primary Respiratory Mechanism

Fig 2 (Below) Interactivity and Interdependance of the systems of the

body and some threats to their functioning ability

Fig 4 (Below) Possible Causes and Effects of Disturbances of the

Primary Respiratory Mechanism

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Because of the extensive influence of the brain and nervous system, the
circulation of the blood and the fluctuation of the cerebrospinal fluid on
the musculoskeletal system and on all the organ systems of the body, it is
not presumptuous to say that the osteopath, craniosacrally experienced, has
resources to look into and sometimes help any patient.

Here follow some examples:

a brain damaged child of 18 months suffering 100 convulsions a day:
attention to her eating habits and two cranially oriented treatments stopped
her fitting entirely; treatment over subsequent years played a part in
helping her to develop her personality and available faculties;
a man who, after dental treatment, had been unable to open his mouth
more than half a centimetre for two days: one gentle palpation and
encouragement to "locked" cranial bones including the sphenoid and
temporals released his jaw;
varied patterns of headache relieved by releasing the frontal bone from the
rest of the face or by lifting the parietal bones away from the temporals;
symptoms in parts of the body apparently unrelated to cranium or
sacrum are analysed and dealt with by studying the fascial connections that
may have become disturbed by, for example, an age-old fall or surgical
operation.
To conclude, Cranial Osteopathy is an honourable but colloquial name
to give to an inseparable component of health-promotion that encourages
appropriate nourishment, structural integrity and psychological harmony of
the individual being cared for. For those interested in pursuing the subject
read Sutherland himself to start with.(10)

References
1 TRIANCE, Edward. Osteopathy, Thorsons, 1986.
2 STILL, Andrew Taylor. The Philosophy and Mechanical Principles of
Osteopathy, Hudson Kimberly Publ, 1902 USA.

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Cranial Osteopathy 04/17/2007 10:30 PM

3 SUTHERLAND, William Garner. The Cranial Bowl, 1939.

4 MAGOUN, Harold I. Osteopathy in the Cranial Field, 3rd Ed 1976.
5 DE JARNETTE, Major Bertrand. Cranial Technique, Nebraska, 1979-1980.
6 UPLEDGER, John E. & VREDEVOOGD, Jon D. Craniosacral Therapy,
Chicago, 1983 + others.
7 KIMBERLY, Paul E. Cranial osteopathy and its application. Lecture Des Moines
Still College of Osteopathy and Surgery, October 23 1948.
8 GOODMAN, J. Chairman's Letter, Cranial Osteopathic Association Newsletter,
Summer 1996.
9 DE JARNETTE, M.B. Lecture notes and personal communication on SOT
10 SUTHERLAND, Adah S. and WALES. Anne L. Collected writings of William
Gamer Sutherland 1914-1954, The Sutherland Cranial Teaching Foundation USA,
1967.

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