The anatomy and function of the Cranial Sacral Complex involves the dural membranes, known as the reciprocal tension membranes, and their relationship to the cranial motion, which ebbs and flows, and the fluid pressures of the CSF. The source and the exact origins of the Cranial Rhythmic Impulse is not known, but can be felt through the cranial bones and their sutures as they move between flexion, extension, internal rotation, and external rotation. This dural membrane system gives internal support and strength to the cranium, and separates the brain vertically and horizontally creating four quadrants. This membrane then continues downward and attaches at various places along the base of the cranium, upper cervical spine, and at last on the sacrum at the level of the S2 tubercle. This movement, which is studied and measured at different places in the spine, is thought to be at a fulcrum around the sphenoid-basilar junction, and is enhanced at birth by the secondary, or diaphragmatic respiratory mechanism. So on inhalation the sphenobasilar junction is thought to move into flexion, while on exhalation it moves into extension. These motions are most closely observed and utilized by the Sacral Occipital Technique. Sutherland and DeJarnette
Dr. William Sutherland is noted as the first to discover what he termed the Primary Respiratory Mechanism. It was soon confirmed by Dr. Major Bertram DeJarnette, who was first an Osteopath and later became a Chiropractor, and who developed a unique system of study called the Sacral Occipital Technique. SOT is based on three basic categories of dysfunction:
I. The synovial part of the Sacro-Iliac joint slips, placing immediate stress on the dura, the dural sleeve, the cranial dura. The primary respiratory cycle becomes disrupted creating dural torque and dural fibrillation, resulting in a Category I lesion. Thus Category I relates to visceral and central symptomatology. II. If the weight bearing hyaline portion of the S-I joint slips, the interosseous ligaments stretch and a Category II system manifests with resultant lateral symptomatology. III. If the sacral facets shift creating stress in the lumbar spine, a lumbar disc syndrome occurs, deteriorating into sciatica, and the Category III patient emerges.
The mechanism which allows craniovascular and cerebrospinal fluid flow is termed “the sacral pump”. When talking about this sacro-occipital pump it is important to remember these relationships: the L5 and atlas reciprocate with one another; similarly L4 and the axis; the ilia reciprocate with the temporal bones; and the coccyx with the sphenoid. So when sacral dysfunction occurs and we know its relation to the ilia, coccyx and L5, it is easy to see that reciprocal tensions will occur at the temporal, sphenobasilar, and atlas - all areas where the dural membranes have firm attachments.
Category I: In the early years of life, either from birth trauma or other traumas, we develop the Category I pattern of anterior and reciprocal posterior movement of the inominates, giving rise to dural torque in the spine and cranium, affecting the sacro-occipital pump and influencing biochemical changes at the spinal roots.
Category II: Unless reversed this process will go on compensating until the stress through further trauma causes interosseous ligamentous strain, and the weight bearing area of the spine weakens. This renders the typical Category II lesion, in which the sacrum slips and produces compensations at the hips, knees and ankles.
Once the biomechanics of the pelvis have been compromised, further compromises begin to take place at the pectoral girdle affecting the cervical spine and giving rise to shoulder, arm, and elbow symptoms. Then the crucial area of the temporo-mandibular joint begins to develop symptoms. Because of the direct reciprocal relationship between the SI and the TMJ trauma to one will begin to cause compensatory dysfunctions in the other. Category III: With time the body begins to adapt to Category II and makes compensations in the sacral facets, destroying the biomechanical function of the lumbar spine resulting in disc degeneration, and culminating at the chronic extreme in prolapse and fragmentation of the disc. Breathing Differential: Due to the primary and secondary respiratory mechanism the cranium and the sacrum are in constant motion, and thus differentiation among the categories when the patient is standing becomes apparent when observing the patient in relation to a plumb line. Category I due to stability of the SI joint, but with anti-post rotations of the inominates, tends to cause an anterior-posterior body sway. Category II due to the slippage of the sacrum and the dysfunction of the weight bearing facility will demonstrate a lateral sway. Category III is classically protective to prevent further damage to the disc and nerve root and so is motionless.
Commercialization of Craniopathy
Dr. John E. Upledger, an Osteopath in Florida, has brought cranial sacral therapy to the average practitioner as a light touch technique on the spine and sacrum. He has taught it very carefully and simply so as to cause no harm when teaching it to various body workers and massage therapists, all with varying degrees of knowledge. However the original Osteopaths and Chiropractors who specialized in these regions were called Craniopaths. They studied in detail the biomechanics of the cranial bones and the reciprocal tensions of the membranes, and how to help patients with very serious EENT pathologies, and other neural, biomechanical and developmental problems of the cranium. It is important to know that they had mastered the art of manipulation and so knew that once they took pressures off the spine they had to relieve the compensatory pressures in the cranium. Today many individuals are disappointed to not get results in solving their physical medicine complaints with their experiences of this technique. Cranial work should be performed within the context of a comprehensive spinal treatment, including spinal mobilization and/or manipulation to release or relax the dura-meningeal tube as the first level of intervention, before cranial work can be effective.
Holistic Physical Therapy: Integrating Physical Therapy , Chiropractic and Myofascial Massage Techniques Gale McIntosh PT, DC 650.563.4076 (Se Habla Español) 300 Main St. Suite 5, HMB, Ca. 94019