CranioSomaticsTM: compensatory
relationships
By G. Dallas Hancock,
DC, MS, LMT, & Flo Barber, LMT
In presenting talks on
cranial techniques at various organizations, we generally ask for a show of
hands on how many therapists have studied craniosacral procedures and how many
actually use craniosacral procedures.
The first question generally results in a much larger count than the
second. Inquiry into the reasons why
trained craniosacral therapists are not using the procedures frequently elicits
concerns about their lack of ability to demonstrate, either to themselves or to
the client, causal relationships between restrictions in the craniosacral
mechanism (which the client often can not feel), and the somatic dysfunctions
they do feel. Some therapists feel that
this creates a credibility gap between themselves and the client and/or the
referring physician. There appears to be
a need for an ‘objective’ and integrated approach to the evaluation and
treatment of cranial ‘lesions’ (distortions) that recognizes and utilizes the
relationships between cranial and somatic components.
Sutural restrictions can
generally be correlated with patterns of altered function of muscles, fascia,
and joints elsewhere in the body. For
example, a practitioner knowledgeable in craniosomatic principles should be
able to identify the specific sutural restrictions related to a shoulder
dysfunction or, conversely, the muscle, joint, and fascial involvements created
by a restriction in the nasomaxillary suture.
We coined the term ‘craniosomatic’ in 1996 to express this concept of
the very extensive and predictable relationships that exist between the cranial
sutures and specific muscles and joints throughout the body.
These interrelationships
present potential problems relative to identifying the primary cause of
presenting symptoms, and validating treatment outcomes. For instance, if identified craniosacral
restrictions are released, and these restrictions were only secondary
(compensatory) to dysfunctional muscles, fascia, or
joints elsewhere in the body, the restrictions may recur on weight bearing or
walking. But, how many therapists ‘road
test’ their patients and then reevaluate them to find out if the restrictions
have recurred? How many practitioners
test muscle function before and after treatment? Although functional muscle testing was developed
in 1912 by Robert Lovett, M.D., to evaluate neurological damage in polio
patients, its use to identify functional weaknesses in compensation patterns is
an effective pre- and post- treatment assessment procedure. Whatever the
evaluation methodology - and it is preferable to confirm findings using more
than one method - post-testing is essential after the client has been weight
bearing and has walked a short distance.
Many therapists are not
aware of numerous types of compensation patterns that adversely affect
treatment and the evaluation process.
Some of these patterns are related to weight bearing, some occur with
normal joint movement, and others occur as part of repetitive motion disorders,
but all affect the craniosacral mechanism and the musculoskeletal system. Regardless of the cause, each cranial SBS
pattern (torsion, sidebend, etc.) will present as a
unique full-body compensation pattern.
The symptoms are specific to the SBS pattern and include alterations in
the function of the cranial mechanism, eye movements and TMJ, and specific
patterns of hyper- and hypotonic muscle function. Various other soft tissue involvements may
also be identified. Several categories
of other compensatory patterns are presented here.
The first category consists
of specific postural compensation patterns that are universally present in the
patient population. These patterns,
which I have named Primary Distortion PatternsTM,
are present at birth (inborn). They can
be confirmed by functional muscle testing, palpation, etc. Although they can be temporarily released by
typical cranial techniques while the patient is supine, these Primary
Distortion Patterns (cranial restrictions, postural distortions and functional
muscle weaknesses) will immediately return on weight bearing. However, these Primary Patterns can be
permanently eliminated at any age, using CranioStructural IntegrationTM
techniques, which we have developed and teach.
It is not known if these corrections are sutural, muscular, fascial,
membranous, ligamentous, or reflexive in nature, but
the benefits are very long-term or permanent.
A second category of
compensation patterns involves the facilitation/inhibition reflex patterns
associated with flexion and extension of most major joints. For example, if the client flexes the wrist,
elbow or ankle, the antagonist muscles (the extensors) will be weakened on the
same side. This temporary compensation
may affect the entire body, including cranial sutures, and generally lasts up
to 20 seconds (but sometimes longer).
A third category of
compensation patterns appears to be associated with facilitated neurological
pathways resulting from trauma or intense repetitive motion. These compensation patterns may be reflexive
in nature, and can last for extended periods, producing self-perpetuating
patterns of hypertonicity. They can involve virtually any joint, and may
predispose tissue to injury. These
facilitated patterns are often associated with chronic and/or acute pain
patterns, such as trigger points, carpal-tunnel syndrome, tennis elbow,
etc. These patterns of pain and
dysfunction can be eliminated by Facilitated Pathway TherapyTM,
a new treatment modality developed by Flo Barber,
LMT.
A fourth category of
compensations that definitely should be understood is the correlations between
posture and dental occlusion. Postural
changes involve the muscles of mastication, anterior neck flexors, SCM, and
other muscles. These changes also affect
the sphenoid and temporal bones, directly influencing the position and function
of the maxillae and mandible.
Conversely, alterations in occlusion immediately affect the position and
function of the sphenoid and temporal bones, resulting in alterations to the
craniosacral mechanism and posture. Ask
a patient who doesn’t wear dentures, and is missing the molars on either side,
to bring his teeth together normally and bite.
Observe the cranial and postural compensations that occur. There are obvious benefits to be gained by
coordinating dental orthodontic procedures with cranial interventions, a fact
that should be more widely recognized.
Regardless of how evaluation
is done, the effectiveness and longevity of treatment results can be affected
by a number of factors. Although we as
therapists have limited influence over environmental factors that come into
play after the patient leaves our office, we need to be aware of the factors
that we can monitor and influence within our clinic setting. All of the compensation patterns discussed
above affect craniosacral and somatic functions. If the underlying causes of these
compensations and dysfunctions are not addressed, the patient may feel
improvement at the end of the therapy session, only to have many of the
symptoms recur in a relatively short time after treatment. Effective post-treatment evaluation can help
provide the information necessary to identify remaining symptoms and offer the
practitioner the opportunity to address causative factors that remain.
The goal of the therapist
should be to assist each client in reaching optimum health. This is clearly an
ambitious goal. It requires treating
more than just the craniosacral mechanism; it requires treating the body
holistically. CranioSomatic Therapy is a
holistic approach. In our practice we
address the cranial and musculoskeletal systems as a single entity. We treat and eliminate - insofar as possible -
each of the categories of compensation patterns discussed above, and more. We evaluate and educate our patients on other
environmental factors - such as shoes, glasses, fragrances, seating, work
stations, constricting clothes, etc. - on an ongoing basis, to assist them in
moving towards optimum health.
Pre- and post-treatment evaluations should be tools that assist a practitioner in providing more precise treatment. Awareness of the variety of compensatory patterns that affect both therapy and evaluation is one more step towards effective therapy that achieves treatment objectives.
This article was published in the AMTA Florida Journal, Spring 2000, #13; 8-9
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