Cranio Sacral Therapies.  What’s going on?

Cranio Sacral Therapies. What’s going on?

The Saggital Sinus

In mentioning that I was planning a future webinar on spinal cord, dura and meninges, I was contacted with some brilliant questions and thoughts about cerebrospinal fluid and the effect that therapies such as Cranio Sacral Therapy might have.  The theory around the techniques suggests that movement of the cranium in clockwise and counter clockwise directions, influences and improves the drainage from the sinuses into the carotid veins.  There is a popular understanding that congestion of the CSF can occur secondary to trauma or dental work.   

I will admit to knowing not much about the application of the techniques, although I have been on the receiving end of them many times.  I have found them to be pleasing and useful especially during a phase when I was experiencing severe headaches.  I have also known many people who have had their babies and young children treated with cranial techniques to very good effect.

However my personal feeling is that it is unlikely that the work being done by these therapies is having a direct, mechanical effect on dura or CSF.  I just can’t see it. In the fully formed adult head cranial plates don’t move to a degree that can be palpable or affected by the type of pressure usually associated with manual therapy, and neither should they.  The sutured plates are there to give a birthing baby the chance to pass through the birth canal without destroying its mother in the process. Once this has been achieved, the necessity for the plates to move isn’t there, and instead the more important role of hardening and fixing to protect the fragile contents of the skull begins.

Unlike the sacrum, the skull also doesn’t need to transmit load or force through it and indeed if the kind of forces generated through the sacrum were applied with any degree of regularity to the skull, brain damage would soon follow. In an infant I do appreciate that this application would have a different perspective.  

The incredible thickness of the skull, even at its thinnest area, therefore renders the likelihood of direct effect on the dura or meninges unlikely in my view.  However if we are talking about the power of touch to inform every aspect of human behaviour, then all bets are off in terms of what is being achieved.

Putting hands on anywhere, brings an awareness, not just to the localised area being touched, but to all the other areas that are connected to, associated with or affected by the place we are touching.  Most of these associations would not be conscious from the client perspective or intellectual from the therapist perspective, in terms of anatomical or theoretical connections established through research or study.

Instead these connections are things like the time we fell off our bike, banged our head and twisted our ankle and spent two hours in the nurses office gagging to the smell of Germolene and feeling nauseous.  The resulting associations embedded in this experience become part of our physical, mental and emotional psyche and are impossible to untangle or even identify from either side.  The touch that brings all these together even if these realisations are still unconscious, allow a shifting of behaviour and a change of focus of pain or sensation.  More information is put in to the existing embedded memory and pattern and more information allows for greater integration of personal experience, good or bad.

There is considerable resistance to the idea that we aren’t actually doing what we think we are doing or what we want to be doing. The clinging to belief, personal conviction, original training and even research papers, sometimes presents barriers to letting go of strongly viewed theories.  I will get told many times in no uncertain terms, that I am wrong.  That these things do move and that X, Y or Z is happening and that you can feel it under your hands.  Well maybe you can, and I for one have no doubt that things happen in sessions that are way beyond what we can reasonably explain using anatomy, physiology or science of any kind.  All I can do is present what evidence a donor gives me and what I see.  Also logic should prevail to some degree as well.  We know that touch is a powerful promoter of change in every aspect and sense: physical, mental, emotional.

Pterygomandibular raphe

The Pterygomandibular raphe. Still a good distance from either of the actual pterygoids.

The jargon and regularly applied phrases such as ‘dural release’ and ideas around working the pterygoid plates come up and it’s hard to find meaning when looking at either how accessible (or inaccessible) any of these structures are in reality, or what ‘release’ might even mean.  There’s no doubt that working in these locations will bring proprioceptive awareness to the area, but as to what release actually means is anyone’s guess.

If within this filed we recognise the need to influence fluids, then I would suggest that it is not just CSF that is worthy of our attention, but indeed all the wet bits we possess. Therefore I once again come back to the importance of movement and within the movement, the need to create compression and apply compressive forces within the movement, such as squatting or resistance within and as many ranges of movement as possible.  It is these forces, applied regularly and with as much variation as possible that I believe helps effective fluid circulation and is going to be more effective than any physical force that a third party can apply to a body.  However the need for an individual to have the ability to create awareness and focus on areas of their body where movement is restricted, painful or where the acquired lifetime patterns of movement and no movement, have introduced limitations that hold us from moving to our fullest potential.  This is the unique ability that touch confers,

The right touch, in the right place, with the right story, from a compassionate, caring and insightful therapist is something that no amount of science will ever compete with.

Fluids. Keep them moving. We’re dead without them.

One of the big elements that I am interested in is how different types of fasciae act as conduits for fluid to flow through. Some of the spaces are microscopically small, but still allow fluid to move through under pressure. Other spaces are enormous and are filled with big cells like adipocytes. In either instance, it’s this movement of fluid around the body, carrying nutrients, cells and facilitating lubrication, promoting homeostasis and movement.

Every system in the body is designed to move, clean, eliminate, replace or feed our fluids.  Cells travel around in fluid.  Red blood cells get moved around the body carried in plasma, which is effectively a connective tissue.  This fluid gets cleaned out by the lymphatic system and in turn organs such as the spleen and the thymus.  The spaces that are created by our fasciae need to be kept open if the flow of fluid is to be optimal.  As with any blockage or closure, there is always the chance for a re-route, but do it too often and we end up with potentially bigger blockages.

These spaces can be glued or fixed by lack of movement, infection, scarring from injury or surgery but however the get blocked the potential for health issues will not be far behind.

Fascia is mostly non-cellular in its construction and why it’s part of what we call the extra cellular matrix. Its function as a scaffold and a support mechanism however is vital to allow the movement of interstitial fluids. The multiple directions of the fascia allow for multiple directions of fluid. Even in tissues in the deceased, the tissues as seen under a microscope, show fluid rushing around, influenced enormously by external pressure and movement.

I suppose that it’s pretty obvious that we need to move about and that it feels good to get a massage.  But watching this movement of fluid moving around makes that sense of needing to move, even more pronounced.

The Heart and Diaphragm

The Heart and Diaphragm

Got together like love and marriage, like horse and carriage, like peanut butter and blue cheese.

I’ve long been interested in what I call ‘virtual relationships’ around the body.  Places where things appear together to such an extent that they probably have to have some kind of symbiotic and functional relationship.

I also happen to have a passion for undertaking very detailed and fine dissections where I can spend time seeing how tissues both weave together and separate.  It’s not something I generally have a lot of time to do in a class, and any opportunity to spend time alone in a dissecting room will find me undertaking a task on my long list of “I wonder ifs…” 

The fibrous pericardium of the heart is generally shown as being continuous with the top of the diaphragm.  In open heart surgery (as far as I can ascertain) the pericardium is opened and then not closed up.  I presume because it will close itself.  I haven’t been able to confirm this with a heart surgeon by the way, so any corrections will be gratefully received.  This picture whilst showing the connection of the pericardium to the diaphragm, also happens to show the beauty of the blood vessel network and gossamer nature of this structure.

In any event the linking of the heart to the diaphragm tells us that every time we breath in and out 15-20,000 times a day, our heart rides up and down on our diaphragm, probably contributing  to the momentum of heart movement and blood flow. From a geeky perspective I wondered as to the extent of this connection. Could the heart be separated from the diaphragm intact?  After a few false starts and some holes in the pericardium, I managed to perfect this dissection which you can see here.

I regularly show how the fascia of the diaphragm is to all intents and purposes, continuous with the fascia of transversus abdominus and that there is also a continuation of the parietal pleura over the diaphragm and incidentally both these pictures don’t make clear that there is another lining over the top of the diaphragm which is parietal pleura.  It’s pretty difficult to separate this although I have done it in sections.  Perhaps another challenge?

What does it prove?  I have yet to postulate any ideas regarding function, just that it is incredibly interesting and does show these two structures as complete and independent of each other from a biological standpoint. Sometimes the applications come after the demonstration possibility. A starting point would be to name the junction.  Diaphragmatic pericardial raphe perhaps?  Answers on a postcard please!

Anatomy Trains and Unicorns

Anatomy Trains and Unicorns

At a fascia conference in Berlin in November 2018, I was accosted by a lady who pointed at me and accused me of being the man who “doesn’t believe in Anatomy Trains.”  Slightly taken aback I pointed out that in the face of evidence, belief is not required.  Bring me the evidence and I will not require faith.

Before we go any further, allow me to place a very firm stake in the ground here.  I consider Tom Myers to be one of the greatest teachers, orators, therapists and thinkers that we have seen in the last 100 years.  Anatomy Trains is a work of absolute genius and one of the most important contributions to the world of body work and anatomy that stands alongside Job’s Body for importance.  I for one would not be in the place I am without Tom and his work.  I consider him to be a friend and a colleague and someone for whom I have an endless amount of respect and gratitude.  I have taught with him back in 2007 where we ran a dissection workshop in St George’s hospital in London and took him on a tour to teach my Bowen people.  I like Tom.  A lot.

As you might guess, there is a however coming up and you would be right. It’s actually more about how people have taken the AT work on rather than about Tom, but I offer you a quote from the man himself where he explains Anatomy Trains as “imaginary lines of strain in the body.”  If we stayed here, with the word imaginary, then I would have no need for my belief system to be questioned and no need to be accused of several counts of Myers heresy.  Simply put, Anatomy Trains do not exist. There, I’ve said it. They are imaginary and like many things imaginary, serve an excellent purpose when used to illustrate an idea.  Anatomy has needed a model to remind us that there are continuities and connections all over the body that have functional connection and relationships and there is little better in the way of models than the imaginary ATs. Why spoil a good thing?

In the years since I first encountered Tom and the ATs, there has been much dissecting of many cadavers and along the way, the lines have been dissected out and held up as proof that “yes here they are, they do indeed truly exist.” They do not and to suggest they do demeans the originality of the work and its designer.  Apart from the basic idea that the lines are physiologically impossible, cutting something out of a dead body just means that you have a sharp knife, a keen eye and a good imagination. My blog on confirmation bias is a reminder that what we seek to verify we probably will, even at the expense of good science, logic and common sense.

John Webster from California is an ice carver (and a pretty good masseur), renowned for his carvings of swans from ice.  When asked how he performs such feats he claims it is very simple. “Just take some ice and cut away anything that doesn’t look like a swan.”  Anatomy has been creating non-existent structures out of dead bodies for hundreds of years, giving us things like the Iliotibial band and various retinacula, all of which are carvings in the same vein as the ATs and John’s swans.  Certainly instructive and interesting and definitely worth doing, as long as you see the nature of the model you are creating.

I do believe however that I have found an actual unicorn in the shoulder blade.  No really.

Small Spaces

Small Spaces

 

 

 

 

 

The all encompassing word fascia holds some degrees of confusion and variation.  Fascia is a lot of things to a lot of people and depending on what you have read or what your field of thinking or science is, your view of fascia may vary accordingly.  As a connective tissue, it has a lot of properties and is described in many ways.  There are the sheet like structures that form aponeuroses around the body: the iliotibial tract or band (ITB) and the galea aponeurotica or scalp fascia to name but two.

Fascia however has lots of different presentations and formations and it’s worth remembering that as a connective tissue, its primary purpose is to connect.  Sounds obvious I know, but fascia gets imbued with lots of strange properties that in turn generate stories and fantasies around what it is and what it can do.

The main thing to remember about all connective tissues is that they are mostly non-cellular in their make up.  That doesn’t mean to say there are no cells in fascia, just that mostly the fascia is the product of the cell.  This is pretty important as if fascia were mostly composed of cells they would need to consume a lot of energy and would also need to be replaced.  As it is, fascia is mainly protein in the form of collagen and acts as both as a scaffolding and a separator.  The images reproduced here show this really clearly.

The muscle fibres are kept both separated and connected by the connective tissue that runs in between them and around them.  This gives the fibres both strength, integrity but also allows space for fluid and (probably) information to run between and around them.  The fluid is the important bit in all of this.  Fluids in the body not only allow for movement to take place on every level, but also allow for nutrients and waste to be carried around the entire system.

The idea of ‘releasing’ fascia is something that I struggle to get my head around, but is probably best explained as being a method of encouraging movement of fluids through and around connective tissues, where poor fluid movement has become an issue or results in presentation of pain.