I suddenly became extremely busy working at three different therapy centres!

I have been working with an extremely varied client group, with presenting issues such as stomach problems, sciatica, stress, emotional pain, migraine and dizziness.

As one centre closes (Community Foundation for Planetary Healing, Portobello), I am starting work next week with patients with chronic pain, in connection with a hospital pain clinic.

This has taken some time to set up, but a January start seems like as good a time as any.

I am hoping to have a list of case studies on this blog (ensuring patient confidentiality at all times), so that more people can become aware of the wide range of physical and emotional issues that I see in my clinics.

I am attending a postgraduate training course at the end of January: Working with Babies, Children and their Parents.

This will add to my prior knowledge of working with pregnancy issues, birth trauma and post-natal issues and family dynamics in a craniosacral context.

There is so much information out there about craniosacral therapy that I would like to share.  My plan is to write short articles on this blog, so that  craniosacral therapy can be made more accessible to people who are new to the therapy, or not aware of how it can help.

For now, I think it is a good start to say that craniosacral therapy is often what helps the interface between emotional and physical pain to be found, and start to be resolved.

Years of emotional and physical patterns can start to be released.  This can be a lengthy and sometimes uncomfortable process, like any process of change that involves inner work, increasing self-awareness and letting go of unhelpful patterns.

Craniosacral therapy can help with body awareness and self awareness.  It can help with self love, self honesty and self compassion.

This can sometimes lead to huge and ultimately positive life changes, which is what can help people to continue to make progress once a course of therapy is over.

Letting go of emotional and physical conditioning is not something that can be achieved with a ‘quick fix’.  Through time and patience this can happen at the right pace for each individual.

Each individual will find the therapy that works best for them, and for some people, that will be craniosacral therapy and a chance to enter into a new relational field with the self through a therapeutic relationship that promises one thing, amongst many: a journey well worth taking.

I am now working at three different centres around Edinburgh.  This is an exciting time of development, as well as one that requires a lot of patience.  I have started to form a network in Edinburgh with other complementary therapists, as well as pilates, yoga and chi kung teachers (amongst others!).

Each centre is different and has a different energy.  One is a shiatsu training school and therapy centre, with a long list of classes and therapies on offer every day of the week. It is on the West side of the city a few minutes from Grassmarket and on the other side, Lothian Road.  The other is an Iyengar yoga centre, tucked away down a mews road near the top of Leith Walk, which offers classes also to pregnant ladies and new mothers and babies.  There is a small team of complementary therapists working there, sharing the peaceful therapy room.

Finally, I am working at a centre in Portobello, Edinburgh’s seaside town.  This is very much a community based centre and was built up first as a shamanic centre, which has grown and now moved to Balerno.  The offering now in Portobello is community based therapies and healing, low income clinics and yoga classes, as well as other healing activities and opportunities for improving health and well being.

I am mainly offering craniosacral therapy at these venues, although I am still also working as a massage therapist from my home based therapy room.

Things are also gradually moving towards a start date at the Western General, where I will be working with patients with chronic pain, on referral from the pain clinic.

This is an important step for my practice as this will help to bring craniosacral therapy into a wider field and help others in the conventional field of medicine to understand a bit more about it and how it works.

My aim is to raise awareness of craniosacral therapy gradually, and step-by-step, so that more people (medics, patients and other therapists) know about it as an option, especially when dealing with long term chronic pain, with no known cause, that often co-exists alongside complex emotional issues and trauma.

The rhythmic nature of our bodies, which are full of fluid, is the basis for Craniosacral Therapy and how it works.  The therapist will tune into the fluid motion of your body and help to support any changes needed to free up motion and space.  The therapist will also work in connection with your nervous system, supporting it to relax and release any unwanted cycling energy.

Sometimes, it isn’t possible for all of life’s challenges to be processed as they happen, and this can mean that our bodies store unresolved experience, which can overload the body and mind, leaving us feeling depleted, overwhelmed, or even in pain.  Craniosacral Therapy can help to resolve some of these issues, so that being pregnant and preparing for birth, or caring for a new baby does not add to the feeling of overwhelm, or stress.

Craniosacral Therapy can help you to feel more “at home” in your own body, to release stress and strain and to promote a deep feeling of well-being.  The body’s natural healing processes are boosted during a session and issues such as sleep problems, pain and anxiety can start to be resolved.

The therapist will skilfully “listen” to your body, starting a process where the body feels “heard”.  It will start to respond at the deepest levels, both cellular and neural, enabling physical and emotional shifts to take place.  Craniosacral Therapy offers the brain and the body a deep form of communication that brings back the primal physical experience of relational touch.

For mothers and babies, it can improve comfort throughout pregnancy, post-natally, and the early months of your baby’s life.  Pregnancy is a time of change, both physically and emotionally, and Craniosacral Therapy can help to address the effects of stress and external pressures, to enable you to embrace these deep emotional and physical changes from a resourced and supported place.  Craniosacral Therapy can also help to reconcile internal and external awareness, which is helpful when your body and developing baby are going through change.

Mothers and babies can often need support through the first few months of a baby’s life, to address any issues from the actual birth (physical and emotional), as well as coping with the adjustment to a new and deeply connected being-to-being relationship.  Craniosacral Therapy provides a space for mother and baby to enjoy time together, experiencing stillness and getting to know their own precious relational field.

Treatments are carried out fully clothed, while lying on a treatment couch and can be easily given to mothers and babies separately, or together.  Craniosacral Therapy treats the person as a whole and the client’s own system (mother and baby)  often chooses priorities for treatment.  The basis for each treatment is that health is always available.

1. Establish sense of safety: craniosacral therapists work on the basis of establishing safety during sessions, so that clients can feel safe and supported to process deeply held physical and emotional patterns.  This is done through sensitive verbal skills and interaction with the client, and the process of negotiating contact, creating space and slowing things down when necessary.

2. Regulate affect: Working with the autonomic nervous system, to down-regulate the stress response, helps to regulate the deep brain structures that cause arousal.

3. Re-establish attachment: Regular sessions with a craniosacral therapist can give the opportunity for a new and trusting relationship for the client.  Along with the deep physical and emotional changes that often occur as a result of craniosacral therapy sessions, the therapist can help the client to process these changes and  achieve a sense of resolution, using verbal skills and deeply listening to the body and creating space for the changes to be integrated.

Craniosacral therapy supports and develops the felt sense and body awareness and helps the client to improve their relationship with themselves, as well as supporting and activating the social engagement nervous system, which in turn supports the client to engage more easily with the outside world.

4. Enhance the brain’s executive functions: as explained in a previous post on ADHD/ADD, craniosacral therapy supports the system as a whole and is useful for treating hypo- and hyperarousal states that may affect cognition and cortical functioning.

5. Reframe and integrate traumatic experiences:  Resources, body awareness and the felt sense are key in the trauma healing process.  Through regular craniosacral sessions, clients can learn more about the feelings and sensations that accompany traumatic memory or post-traumatic stress reactions and over time self-regulation can be integrated into daily life, empowering the client.

Craniosacral therapy can help to introduce new resources into a client’s life, to help break the negative feedback cycle that creates the ‘unsafe world’ that traumatized people often find themselves in.

Most sources agree that an adult ADD/ADHD diagnosis is based on relevant behavioural tendencies as a child (through retrospective questioning). Children or adults can have ADD or ADHD, although the official term used by the American Psychiatric Association diagnostic criteria (DSM) is ADHD.

The DSM-III-R behavioural diagnostic criteria for a child will look for at least eight of the following behaviours occurring over six months with an onset before seven years old:

• Often fidgeting with hands or feet or squirms in seat
• Has difficulty remaining in seat when required to do so
• Is easily distracted by extraneous stimuli
• Has difficulty awaiting turn in games or group situations
• Often blurts out answers to questions before they have been completed
• Has difficulty following through on instructions from others
• Has difficulty sustaining attention in tasks or play activities
• Often shifts from one uncompleted activity to another
• Has difficulty playing quietly
• Often talks excessively
• Often interrupts or intrudes on others
• Often does not seem to listen to what is being said to him or her
• Often loses things necessary for tasks or activities at school or at home
• Often engages in physically dangerous activities without considering possible consequences

(Hallowell and Ratey, 1995, p200)

In diagnosing an adult the criteria is for at least 12 of the following behaviours occurring on a chronic basis, and a childhood history of ADD (Psychiatrists Hallowell and Ratey have compiled this list):

• A sense of underachievement, or not meeting one’s goals (regardless of how much one has actually accomplished)
• Difficulty getting organised
• Chronic procrastination or trouble getting started
• Many projects going simultaneously; trouble with follow through
• A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark
• A frequent search for high stimulation
• An intolerance of boredom
• Easy distractability, trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an ability to hyperfocus at times
• Often creative, intuitive and highly intelligent
• Trouble in going through established channels, following ‘proper’ procedure
• Impatient; low tolerance of frustration
• Impulsive, either verbally or in action
• A tendency to worry needlessly, endlessly and to scan the horizon looking for something to worry about, alternating with inattention to or disregard for actual dangers
• A sense of insecurity
• Mood swings, mood liability
• Physical or cognitive restlessness
• A tendency toward addictive behaviour
• Chronic problems with self-esteem
• Inaccurate self-observation
• Family history of ADD or manic-depressive illness or depression or substance abuse or other disorders of impulse control or mood

(Hallowell and Ratey, 1995, p201-2)

ADHD and ADD are labels that conveniently group together co-existing behaviours that conventionally and by default are classed as ‘pathological’ and are usually treated by drugs.

What causes ADHD?

The exact cause and origin of ADHD/ADD are unknown, although several theories have been put forward – the newer neurobiological theories distinctly more helpful than the earlier ones of bad parenting and bad behaviour.  There is also thought to be a genetic link, although much research into this is still inconclusive.

Researchers (many of which have ADHD/ADD themselves) are keen for research into ADHD/ADD as a syndrome to continue, as well as the removal of the stigma of the pathology, or disorder.

It is generally agreed now that ADHD/ADD has a neurobiological origin, involving the brain and the CNS.  The exact mechanism of the ‘disorder’ is still unknown.  There is no single gene, neurotransmitter or lesion of the brain that has been found to cause ADHD/ADD.  Also, the attentional system, which is involved in consciousness, waking experience, actions and reactions involves nearly all the structures of the brain.

Scientists have not found a way to measure the specific neurotransmitter imbalances that are responsible for ADHD/ADD, however there is enough evidence to say that ADHD/ADD is caused by altered neurochemical systems.  Hallowell and Ratey state that ADHD/ADD is most likely “a disregulation along the catecholamine -serotonin axis, a dance where one misstep by one partner creates a misstep by the other” (p. 274).

Experiments with glucose uptake have located differences in the frontal region of the brain – the regulator of behaviour – in adults with ADD.  Glucose metabolism and uptake was lower in adults with ADD, with resulting lower energy use in the brain.  This was widespread throughout the brain, and most markedly in the prefrontal and premotor regions (Hallowell and Ratey, 1995, p275).  This depressed frontal lobe activity is seen as a form of ‘disinhibition’.

An ‘inhibition-disinhibition’ framework is useful for understanding the experience and behaviours of a person with ADHD/ADD.  This theory suggests that it is the inability to stop receiving messages that causes the distracted patterns of behaviour in those with ADHD/ADD (Hallowell and Ratey, 1995, p282).

How is ADHD treated conventionally?

The primary symptoms of ADHD/ADD (inattention, distractability, impulsivity, minipanic) are medicated using stimulants or antidepressants, which enhance certain neurotransmitters.  The secondary symptoms of ADHD/ADD are treated by a wider range of drugs with a range of actions, depending on the symptom eg: outbursts of rage, impulsivity, OCD.

Medications for ADHD/ADD interact with the catecholamine system (epinephrine (adrenaline), norepinephrine (noradrenaline) and dopamine) to correct the dysregulated attentional processes and stop the ‘rush of experience’.

Both stimulants and anti-depressants increase the levels of neurotransmitters they affect allowing more of them to be available for use by the brain – specifically enhancing the functioning and use of neurotransmitters in the frontal region, smoothing out and regulating attentional functioning.

The exact location of the drugs mechanism in the brain is unknown, because of the lack of precise knowledge about the genesis of ADHD/ADD.  One theory is that the drugs work on an impaired action of norepinephrine in the limbic system – in between the lower brain and the cortex.

The effects of the drugs are felt in the cortex and stimulants have an immediate effect, indicating that they work directly at the synapse, improving cell-to-cell communication.  Other drugs for different neurobiological disorders work more slowly, on building receptor receptivity, for example.

Conventional approaches often combine medication with psychological therapies such as CBT and psychotherapy.

How can craniosacral principles be applied to the treatment of ADHD?

According to one source, there are several conditions that may “accompany, resemble or mask ADD” (Hallowell and Ratey, 1995, p203).  These include:

• Anxiety disorder
• Bipoloar disorder or mania
• Caffeinism
• Depression
• Disorders of impulse control
• Fatigue, chronic
• History of fetal alcohol syndrome
• Hyperthyroidism or hypothyroidism
• Lead poisoning
• Learning disabilities
• PTSD
• Personality disorders
• Substance abuse
• Tourette’s syndrome

With this range of conditions, while it is a given in conventional medicine that each of these separate conditions would receive separate treatment methods, or drugs, the fact that they may also resemble or mask ADD supports the idea of wholeness that is central to craniosacral therapy. Underneath the symptom(s) is the wholeness of the system itself, and the same basic structures and mechanisms that can be resourced and supported through craniosacral therapy.

In relation to ADHD/ADD it is also interesting to note that there is not one single structure in the brain that governs attentional systems and behaviour, and that the exact mechanism of the problem is unknown.  Where conventional medicine works on the basis of narrowing down the focus of treatment, to the catecholamine-serotonin axis, for example, craniosacral therapy looks to work with the system as a whole, including all the structures that may or may not be involved in causing the symptoms of ADHD.

Ideas that there may be a genetic cause to ADHD/ADD are pre-empted by epigenetics and gene expression, which is an underlying theme in craniosacral approaches (Kennedy, 2011)

Addressing pre- and perinatal issues can also help to shift from identifying with symptoms to working with the whole picture.

Maternal stress and smoking has been linked to ADHD symptoms (Rodriguez and Bohlin, 2005).  This raises the question of how the nervous system of the developing baby is affected and primed by stress in the womb.  A baby can become ‘programmed’ to deal with a stressful environment, with a tendency towards sympathetic nervous system activation.  Similar research has shown that stress during pregnancy can affect neurobehavioural development (Van de Bergh et al, 2005).

Birth trauma often causes sympathetic nervous system activation and dissociative patterns, which Sills believes are linked to attention deficit problems (Sills, 2004, p. 257, 260, 320, 371).

Structural compressions and torsions can affect areas of the brain that cause symptoms of ADHD/ADD (Dalton, 2011).  Dalton also suggests that restricted drainage of blood and cerebrospinal fluid from the brain (cranial venous sinuses), which can often happen as a result of structural birth trauma, is also a common indicator when there are symptoms of ADHD/ADD present.  Issues with the occipito-atlantal joint as a result of birth trauma are also thought to be a common indicator (Upledger, 1999).

Generally, using craniosacral principles and treating the whole person would include: orienting to the RTM, cranial bones, cranial venous sinuses, brain, spine and spinal cord, and assessing for and treating hypo- or hyper arousal states.  Changes through craniosacral therapy would free up pressure on and disregulation of the CNS, which could bring about a relief of symptoms.

References

Driven to Distraction: Recognizing and coping with Attention Deficit Disorder. E. Hallowell and J. Ratey (1995)

Craniosacral Biodynamics, Volume Two. F. Sills (2004)

Is ADHD really a Genetic Disorder? G. Kennedy (2011)

Are maternal smoking and stress during pregnancy related to ADHD symptoms in children?  A. Rodriguez and G. Bohlin (2005)

Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review.  B. R. Van den Bergh, E.J. Mulder, M. Mennes and V. Glover (2005)

ADD, ADHD, Hyperactivity.  J. Dalton (2011)

Symptoms and Conditions.  J. Upledger (2008)

ADD Holistic Discussion Group.  J. Upledger (1999)

Trauma therapist and psychologist Dr Susanne Babbel gives an excellent outline of how traumatic experiences and unprocessed emotions can lead to chronic pain.

“PTSD and chronic pain are often connected, and both must be addressed in order to help a person be fully functional again. Although one might not be aware of the lingering effect of the trauma, or believe that the traumatic event has been put behind them, the body could be clinging to unresolved issues.”

This is a quote taken from Dr Babbel’s post, which also advises a combination of psychological and physical therapy is recommended to alleviate the issues that combine to create chronic pain.

Craniosacral therapy is an excellent resource for those who are traumatized and in pain and therapists are often trained in verbal skills to help clients verbalise the thoughts, feelings and emotions that arise during sessions.

Focusing on deep body-centred release can also prevent re-traumatization, which can sometimes happen with purely talking-based therapies.

The article goes on to explain how parents can use touch in different ways to help their children stay calm, calm down and to develop a close physical bond with them.

This also speaks to me of the Porges vagal brake theory, where stress and the stress response is down-regulated by stimulating the vagus nerve to kickstart its parasympathetic effect – and touch is one thing that can help with this process.

This is also one of the system-wide effects that craniosacral therapy can have through therapeutic touch.

Read more about the vagus nerve.

A recent client describes her experience of Craniosacral Therapy:

“For the past two years I have been trying to overcome a debilitating and painful frozen shoulder – at times it felt as though I had lost the use of my arm.

“Through various complementary therapies (Thai Massage, Hot Stone, Swedish Remedial and aqua aerobic exercise) I have regained the use of my arm, but it had left me with a recurring pain in fingers 4 and 5 of my left hand – described by my Consultant as an aggravated ulnar nerve.

“Conventional treatment could only advise physiotherapy, but I found that created more problems than it solved.

“A close relative recommended Alison for Massage and Craniosacral Therapy. Craniosacral was a completely new experience for me and I found the treatments wonderfully relaxing and I have been known to drop off during treatments.

“Alison followed a series of different holds and positions – during which I experienced lots of colour visualization and deep relaxation and over a course of 8 – 10 treatments, the ulnar nerve pain has considerably lessened to a point where I have not experienced it at all now for several weeks.

“I really do feel Alison has got to the source of the problem and I would without hesitation recommend Craniosacral Therapy with Alison.”

(Image from Hughston Health Alert)

Often people have not heard of this therapy, and don’t really understand it.  It can be described and explained in many different ways, referring to the relationships between the tissues, nerves, joints, fluid and bones of the body.

I think an important message we need to get to our clients is that CST may often help with certain conditions that have not responded to other treatment. This can help prevent unnecessary suffering, as well as promote a greater understanding of the physical body and the emotions, through the framework of CST.

We treat the body as a unified system, while at the same time paying attention to the parts that need it – this includes the emotions that sometimes arise.  The fundamental premise is that we are seeking to support the health in the body, rather than curing ‘dis-ease’.

This blog post on the organising principles of our inherent health, explains how certain conditions and physical symptoms can happen on the road towards health and:

“in seeking to stop them, this quite often involves medicating these symptoms, shutting down the discharge process and thereby increasing the degree of excess, toxicity or entropy within the body. It is through continual suppression of acute symptoms, whether physical or emotional that we set the scene for the development of more chronic conditions later on.” (Graham Kennedy RCST)

Craniosacral Therapy ultimately supports the system towards greater functioning and organisation, however complex that journey might be.

(Image from Borders Therapies)

Her findings state a strong case for the benefits of craniosacral therapy for persistent pain conditions, where conventional treatment is not providing any relief for chronic pain, and complex cases involving trauma.  I have had similar results with the reduction of persistent pain and nerve irritation with a recent case study client.

Craniosacral therapy in a physiotherapy out-patient department

Sheila Beer, data analysis Fiona Thorne

I had given up my practice as a physiotherapist for some years but when my husband was made redundant I had to find a job. I had been using CST for some eight years when I started looking for work as a physiotherapist. I had to be honest about the way I worked and as a result several physiotherapy departments didn’t want my skills.

However, one superintendent physiotherapist at my interview questioned me about my work and was interested and discovered that I could work with chronic pain patients and I was offered a part-time job in a NHS physiotherapy department.

How the NHS had changed since my days working in the service as a newly-qualified physiotherapist! There were more forms, paperwork and acronyms; and I had to learn a new language and get used to being treated with scepticism by some colleagues.

For six years I worked in a busy physiotherapy department, mostly as part of the pain management team. Increasingly I found that I had difficulty with patients being told that there was nothing that could be done for their condition. They would be taught how to live with, or ways of reducing, their pain.  This presented me with a real dilemma since I believed more could be done to help them.

During and following the treatment course, medication tended to be reduced or discontinued

As a result my work was separated from the pain management team. The patients I saw challenged me to the limit of my skills. Most had significant stories to tell. My colleagues began to realise that there was something that could be done. Over time my work evolved and I found I needed CST skills but that verbal skills were just as important. Fortunately I had always been interested in trauma work and as a result had done many courses and the six-month introductory psychotherapy course at the Karuna Institute.

The results of my work were positive and an internal audit of my work was done by Fiona Thorne, a colleague in the physiotherapy department.

Results

Patients were treated with craniosacral therapy and supported with verbal trauma skills at the physiotherapy out-patients department at the Great Western Hospital, Swindon. It was a group of patients who had symptoms which were difficult to treat and the work produced outstanding results.

The patients referred for treatment often had multiple symptoms. They had already failed to respond to conventional manual therapy treatments, including physiotherapy. Some exhibited physical and emotional trauma from: bereavement, rape, different kinds of abuse, road traffic accidents, and industrial injuries. Many patients were highly medicated and had had numerous treatments and tests which frequently came back as ‘no abnormality detected’ (NAD).

Patient group receiving craniosacral therapy within the physiotherapy department – 2005

*no further Outpatient Physiotherapy Department (OPD) treatment required

Conclusion

Prior to this treatment these patients had used a significant amount of NHS resources but with little benefit. With these types of patients it appeared that the combination of hands-on and verbal skills was essential for the patients to be able to process the trauma or experiences held within their tissues which had been maintaining their physical symptoms. During and following the treatment course, medication tended to be reduced or discontinued, saving money for the NHS. Early identification of these patients would prevent further deterioration in the patient’s conditions and would save costs on unnecessary medical consultations and tests. Physiotherapists are in a unique position to do this work.

I wish to express my thanks to the colleagues I worked with, especially Fiona Thorne, for their belief in me and encouragement to do the work. My thanks also go to Franklyn and Maura Sills, Anngwyn St Just, Ray Castellino and Babette Rothschild for the skills I learnt on their courses. Without these skills my work with these complex cases would have been impossible.

We are keen to hear of other people using this approach.

Sheila Beer MCSP, RCST Tel 01285 720426

Fiona Thorne MSc, MCSP email Fiona.Thorne@smnhst.nhs.uk

This article is taken from craniosacral.co.uk.

The Chartered Society of Physiotherapy also covers this audit.

(Image from Round Earth Publishing)