Used with permission. Image by Salvatore Vuono at FreeDigitalPhotos.net. Note: When last visited, Vuono’s portfolio was no longer on Free Digital Photos; however, this photo is still being classified as public domain.
Craniosacral therapy is a gentle treatment approach that works with the natural, self-correcting mechanism of the body and the craniosacral system to detect and release restrictions in mobility and enhance the function of the craniosacral system.
The craniosacral system includes the membranes and fluids that surround and protect the brain, spinal cord, and nerves. Restrictions in the rhythmical movement of the craniosacral system can cause sensory, motor or neurological dysfunction.
The techniques of Craniosacral Therapy were developed by osteopathic physician John E. Upledger, founder of the Upledger Institute. Dr. Upledger based his method on the research of Dr. William Sutherland, another osteopath, who is considered the father of craniosacral therapy.
Sutherland observed that, contrary to general belief, the bones of the skull do not fuse completely in early childhood. This means that through very gentle touch, they can be moved, and consequently, the tissues attached to them can be moved. Furthermore, early in his career, Dr. Upledger realized that the membranes surrounding the brain and spinal cord move in a rhythm, different from respiration or the heartbeat. He developed a technique to palpate and manipulate this craniosacral rhythm.
“Dr. John” taught this technique internationally and widely published his research on the efficacy of the treatment protocol. His research is continuing under the auspices of the Institute and the many students and teachers who continue to scientifically validate the usefulness of CST in treating a variety of complaints.
So what is the technique? Using pressure of about five grams, the therapist is able to palpate or feel the rhythm of the craniosacral fluid moving through the tissues of her clients and uses her evaluation of the flow and restrictions to focus treatment on the causes of dysfunction rather than only on the symptoms. She used the bones, mostly in the head and spine, to manipulate the tissues and fluid that affect the whole body.
The client lies on the heated treatment table and usually remains clothed. It may seem like not much is happening because the touch is so light and the therapist does not move around a lot. Many clients go to sleep, and that is fine. The sense of relaxation may continue for several days as the body continues to heal itself and achieve a greater state of balance. Clients often claim their pain is alleviated for longer periods and their mood is improved. The effects are subtle and tend to build with treatment.
The therapy has been used successfully to treat such disorders as headaches, neck and back pain, TMJ, fibromyalgia, motor coordination difficulties, vertigo, edema, neuropathy and nerve compression syndromes. It is also good for chronic conditions that may have an emotional component such as fibromyalgia, attention deficit disorder, anxiety and depression, and even learning problems.
Craniosacral Therapy also has a strong component that focuses on mobilization of the fascia, the continuous sheet of connective tissue that surrounds the organs, muscles, bones, nerves, vessels and other structures of the body. This three-dimensional fascia runs head to toe, front to back and exterior to interior in the body.
Release of fascial restrictions in one part of the body can affect painful tissues in other parts of the body and cause them to also release. The craniosacral system an be used as an indicator of fascial restriction, and then a gentle myofascial release technique can be used to normalize muscle tone, decrease pain, decrease swelling and increase soft tissue and joint mobility. The benefits are usually immediate. For this reason, CST is considered to be a deep tissue modality even though the client does not disrobe and even though the pressure is only 5 grams.
People of all ages, from babies to grandparents, can benefits from craniosacral therapy. In fact, unless there is a high-risk condition affecting the brain or spinal cord, like an aneurysm or tumor, most people can benefit from CST. Recent research even suggests it is helpful for people with traumatic head injury or autism. In any event, your therapist will obtain a medical history before doing a treatment and may ask you to get doctor’s approval if anything seems contraindicated.
A deep tissue massage is slow work and often focuses on one part of the body for the full session.
Deep tissue massage does not have to be painful. That is a misconception that we at Tapestry Life Resources and Hands On Massage Therapy are trying to dispel.
In fact, if, on a scale of one to ten, your massage goes past the pain threshold of a six or seven, the work is ineffective and probably doing more harm than good. That is because the muscles contract against the pain, instead of lengthening and relaxing.
In general, massage techniques that are used for Swedish or relaxation massage can be used effectively for deeper work. The aim in both is to loosen adhesions, stretch and mobilize connective tissue, and improve circulation and lymph flow. In fact, a good Swedish massage can be the first line of defense against injury since healthy, flexible tissues are less likely to get hurt in the first place.
What separates deep tissue massage from Swedish massage is the depth of the pressure and the speed of the massage. The rule is that the deeper you go, the slower you go. Thus, if you are really having trouble with an area of your body, you may only have time in an hour massage to get that area worked. A full-body massage that is all deep work lasts at least 90 minutes and could last two hours. A look at the way muscles are layered may explain why.
In order to reach the deeper muscles, the massage therapist must first release the superficial muscles. To do this, the therapist may use fingers, hands, fists, knuckles, forearms, elbows, or various massage tools. This can take some time before the superficial muscles are relaxed enough for the deeper muscles to be reached. Less oil or cream is used so that there is less slip as greater pressure is slowly applied. Heat, cold, and sprays may also be used.
Superficial and deep muscles of the back Grey’s Anatomy
Let’s use the back muscles for an example. The superficial muscles of the back act on the upper limb. The intermediate muscles act on the ribs and thorax; the deepest muscles of the back are responsible for keeping the body erect.
If trigger points are found, the therapist may strip, friction or compress these to gain a release. Trigger points are taut bands of muscle fiber that do not relax and that keep the muscle in a shortened state. They are usually more painful than the surrounding muscle tissue, and they refer pain to other parts of the body. Trigger point therapy, also called neuromuscular therapy, is often combined with deep tissue massage. Its focus is these taut bands, and although trigger points can hurt as they are released, the therapist should not push beyond the pain threshold of a six or seven.
A true deep tissue massage focuses on the spreading and lengthening of the connective tissue sheath. Deep tissue techniques are based on the work of Ida Rolf who developed a technique called Structural Integration. Her principles have been widely adapted into other connective tissue massage therapies.
Beneath the skin and connecting every part of the body is a fibrous sheet of connective tissue called fascia. The fascia surrounds the bones, muscles, and organs. Indeed, although it is is basically a single sheet of mesh, it wraps individual tissue fibers as well as the whole structure (ie, individual muscle fibers and the whole muscle). Thus, connective tissue health is essential to painless movement. If the surrounding fascia is restricted, so is the muscle. Denser connective tissue forms the tendons and ligaments.
Connective tissue is unique in that it is elastic, which allows it to be elongated. However, the therapist must employ precise levels of palpation, pressure and energy to effectively make changes in the tissue. Simply massaging, kneading or compressing the fascia does not change or elongate the connective tissue. Fascia and muscle are different types of tissue, and they require different approaches. Your therapist will be trained to apply these techniques.
The fascial layers are worked one at a time, progressing from superficial to deep just as with the muscle layers. The superficial layers must lengthen and become more elastic and supple before going to the next, deeper layer.
Often the reason deep tissue massage hurts is that the therapist may be trying to achieve releases too quickly. While it is appropriate to work at your pain threshold, the therapist should not exceed your threshold. If she does, it is up to you to tell her so. Furthermore, you may have to decide to forego a full-body massage and ask that the therapist concentrate on one troublesome area so she is not rushed. Alternately, you could schedule a longer massage appointment.
Finally, you need to drink water and take a hot bath in Epsom salts or apple cider vinegar when you get home. You always hear this after a massage, but do you do it? The water flushes toxins and helps keep the connective tissues hydrated so they can heal. The heat of the bath and the properties of the salts or vinegar also remove toxins and help relax the body more fully. Stretching or other exercises may also be helpful.
Deep work does not have to be painful if your therapist is knowledgeable and if you communicate with her about your pain level, You should be willing to limit your massage to a trouble area, to schedule a longer massage session, and/or to return for a follow-up visit to achieve the best results with minimal pain. Finally, you need to practice self-care and follow your therapist’s advice about proper hydration and post-massage detoxifying.
If you have heard massage therapists talk about Swedish massage but are unsure just what that means, you are not alone. The term is so confusing that many massage practices have started using terms like therapeutic massage and relaxation massage to describe the technique and avoid confusion.
While the term Swedish massage may conjure up images of a tall, blonde Bjorn pounding on your back, the term actually comes from the nationality of the technique’s originator, Per Henrick Ling. It is characterized by the application of firm but gentle pressure on the more superficial muscles, which presses them against the deeper muscles and bone in order to induce relaxation to the tissues. Swedish is the most popular form of massage in the world.
Recently, I’ve had more and more clients asking for Swedish massage. They are stressed, and although they may have some general soreness or stiffness, the thing they want most is to relax and maybe to get a good night’s sleep. They like the variety of techniques in Swedish massage and the ways you can vary the pressure for different results.
Stripping is a technique that combines effleurage and friction to help therapists release the tension in the suboccipital muscles of the neck.
There are five essential techniques in Swedish massage with a sixth added by some. The first is effleurage, which is a long, gliding stroke whose purpose is to improve lymphatic flow and circulation and to warm and relax the tissues. Next is petrissage, a kneading stroke that rolls and lifts the muscles and pulls them away from the bones. Third is friction, which employs small circular pressure to muscles to release knots and adhesions. After friction comes vibration, a techniques that shakes or vibrates the body to stimulate circulation. Tapotement includes percussion movements such as hacking, cupping, and tapping. The final (added) stroke includes bending and tractionwhereby the tissues are gently stretched and mobilized.
One reason that Swedish massage is so popular is that it benefits every major system of the body in some way. Primarily, it relieves physical, emotional and mental stress. It releases accumulated toxins from the tissues and flushes them out of the kidneys, lymphatics, and circulatory system. It increases oxygen flow throughout the body without adding a work load burden to the heart.
Swedish massage also soothes the nervous system and helps clients manage pain by releasing endorphins, the feel-good hormones, into the blood-stream. It can improve digestion and relieve edema or swelling.
The first modality we learned at The Whole You School of Massage was Swedish, and we spent several weeks on it before we worked on anyone other than each other. Clients generally undress fully and are massage in the supine and prone positions and sometimes in a side-lying position. Lubricant is used and sometimes essential oils or analgesics. The techniques used in Swedish can be applied to chair massage as well although the client is usually clothed if getting chair massage.
As mentioned above, another reason for the popularity of Swedish massage is that it can be individualized to the client’s specific needs by varying the strokes and the degree of pressure of the strokes from very light to deeper and heavier. Indeed, Swedish massage forms the foundation for several other massage modalities, including sports massage and deep tissue massage, and it is easily combined with other modalities to give the client a truly personalized experience.
Myofascial massage is a gentle massage modality that releases the connective tissue or fascia through gentle, sustained stretching and pressure. As the underlying fascia releases, muscles relax and mobility improves.
Myofascial massage is usually performed without creams or oils, or alternately, if the therapist has already applied lubricant, she may use the client’s bones for an anchor if she finds a restriction so that a stretch can be achieved. The stretching is usually comfortable and even relaxing. The results of this sustained stretching on the fascial structures provide pain relief that can be quite amazing considering the pressure is so gentle.
Fascia is the thin tissue that covers everything in your body and gives it structure. You’ve seen it between the skin and the flesh when you’ve skinned a chicken. Fascia covers your organs, your muscles and even the individual muscle fibers and cells. Fascia exists in a continuous sheet throughout the body so that a restriction in one part of the body can cause pain in another part of the body even if they seem to have no relation to each other. We call this referred pain.
When you are injured, the muscle fibers and the fascia become tight and restricted and may even stick to each other. Scar tissue may form as the fascial sheet thickens at the injury site and loses some of its elasticity. The gentle stretching action of myofascial massage can release this restriction, restore elasticity and return the muscles and organs to optimal functioning.
To discover the restrictions, the therapist will palpate the skin and underlying connective tissues to locate areas of adhesion and compromised movement. Then she will apply traction, stretching and twisting strokes to loosen the fascia. The movements are slow and deliberate and may last several minutes until the tissue relaxes. When this happens, the client often will feel a sudden sense of release. In fact, if the muscles are holding a great deal of tension, the release can be rather intense. The therapist may follow with Swedish or deep tissue massage to further release the muscles.
Two of the most famous myofascial release teachers in the United States are John Upledger and John Barnes. Upledger and Barnes believe muscles lock because of the stress people hold in their bodies and because of injury and scarring. They teach that myofascial release can release these blockages, realign scar tissue and improve range of motion. Other teachers include Ida Rolf and Tom Myers. Their techniques often go deeper over the course of time, and can be more painful. However, these techniques can quite literally reshape the structure of the body.
Incorporating myofascial techniques into your massage session can result in improved posture and flexibility as the fascial adhesions that constrict muscles relax and soreness dissipates.
One of the benefits of myofascial massage is that it is not painful, so it is a good choice for clients who bruise easily, have thinning skin or who suffer from fibromyalgia-like symptoms. Myofascial massage has also been shown to improve the symptoms of such ailments as migraine headaches, repetitive stress injuries, menstrual cramps, and muscle spasms.
Chances are your therapist is already using some myofascial techniques to your session. To find out more, please speak to your therapist.
I received an email this week from a new client who has been suffering from a headache lasting a week. I remembered reading a series in Massage and Bodywork Magazine, a publication of the Associated Massage and Bodywork Professionals (AMBP)), by Til Luchau. I pulled them out and reread them. Then I did a little more research online.
Luchau divides headaches into two broad categories: tension and musculoskeletal headaches in one category and migraine and other vascular headaches in the other. I’d add a third category: sinus headache. TMJ headaches might be a fourth category, and the general protocols for TMJ jaw pain often relieve the headaches as well. However, these headaches might be better categorized as a subset of TMJ dysfunction.
Luchau provides a chart for musculoskeletal/tension and migraine/vascular symptoms in his first article. My other research differs a bit on some points, but is in general consistent with Luchau. Understanding the symptoms is important because slightly different massage techniques are used for each type of headache. The image below offers a capsule version with hunger and eyestrain headaches omitted in the discussion that follows.
Common types of headaches
Tension headaches often arise when the muscles on the shoulders, back of the neck, under the occiput (posterior inferior cranium), and scalp become tight and pull on the scalp and the lining (dura mater) under the skull. Clenching the teeth is also a tension response and can cause headache even if TMJ dysfunction is not present.
Usually, tension headaches occur on both sides of the head, but if the musculature on one side of the body is tighter than the other, the pain may be worse on that side. It may also be worse in the back of the head, but depending on which muscles are hypertonic, it can be located almost anywhere. The pain is often a dull ache, but it may be more severe. It sometimes feels like squeezing or tightness in the head. Physical activity usually does not exacerbate it.
According to Luchau, the hands-on goal of working with tension headaches is to reduce the myofascial tension.
Sinus headaches are caused when the mucous membranes that line the four air-filled sinus cavities become irritated and swollen. The sinuses produce more mucus as a response, and the mucus that normally serves to moisten the air and soothe the sinuses becomes thicker and adds congestion that further blocks the sinus passages often creating a vacuum within them.
The pain is usually felt as pressure and/or tenderness just behind the eyes, cheeks, and forehead or near the upper teeth or temple regions. The pain may worsen if you lie down although lying down may reduce the pain of tension and migraine headaches. Bending over usually makes sinus headache worse. Your face may be noticeably swollen from a sinus headache.
If the cause of a sinus headache is infection, massage is contraindicated, and you should see a doctor immediately. Otherwise, massage with a hands-on goal of stimulating lymphatic drainage and relieving blocks caused by swelling and congestion may help.
Migraines are believed to be caused when the blood vessels inside the head dilate. Many migraine remedies include vasoconstrictors for this reason. However, according to Lachau, new research may point to another cause.
“Recent research suggests that migraines start as waves of nerve cell hyperactivity sweeping across the brain; the spreading waves in turn activate pain-signaling neurons in the brain stem. The root cause of these neuro-electrical ‘brain storms’ of abnormally increased activity is unknown. The hyperactivity is followed by inhibited nerve cell excitability; the cells seem to be worn out, and this exhaustion may explain difficulty speaking or thinking clearly after migraines” (Luchau, Sept./Oct. 2010).
The pounding or throbbing, sometimes stabbing, pain of a migraine is usually focused on one side of the head. It is frequently preceded by an “aura” or visual disturbance and is accompanied by nausea and sensitivity to light, sound, and odors. Physical activity can make it worse.
Most migraine sufferers have ideas about the triggers that cause their headaches and the symptoms that signal one is starting. They may also know that the massage protocols that work on tensions headaches often have little lasting effect on a migraine. Luchau’s hands-on goal of migraine massage is to reduce cranial compression, and I would agree that even if the migraine is initially triggered by muscular tension or sinus blockage, by the time it is a full-blown migraine, work on the cranium and the cranial fascia is necessary to relieve it.
Sometimes it is hard to tell what kind of headache it is. Generally, a look at the location and quality of the pain and at the response to activity and sensory input can help identify the type of headache you have. However, if you have a sudden, severe headache with no history of migraine headache or a dull headache that will not respond to treatment, you need to see your doctor immediately. Headaches can be a symptom of severe and even life-threatening conditions, stroke for example, and should not be ignored.
The massage protocol for a tension headache will include release of tight neck, shoulder and chest muscles and general relaxation strokes. Luchau’s first article emphasized release of the superficial and deep fascia of the scalp and a concentration of the suboccipital regions. I would add trigger point therapy of specific muscles likely to contribute to headache pain. Indeed, numerous research studies have cited the efficacy of massage, including specific pain-relieving modalities and more general relaxation type massage which tends to improve overall structural alignment and release endorphins into the body, as greatly relieving symptoms of tension headaches and even preventing headache recurrence when massage is received regularly.
Sinus massage with use of lymphatic drainage therapy is effective for relieving the pressure in the sinuses. (See my recent newsletter article on Sinus Massage.) The Lymph Drainage Therapy technique is slow and precise, and it uses feather-light strokes to move the lymph out of the head and into the nodes. It may also include the use of aromatherapy to further open the sinus passages.
Migraine headaches respond well to Craniosacral Therapy, especially intraoral work. CST allows the therapist to decompress the bones of the cranium and balance the blood flow. It also allows for structural realignment. Luchau’s technique uses a little more pressure than CST, but it is similar. (Trigger point therapy is often not as effective on migraines and on tension headaches.)
According to Luchau, the effect of this cranial work may be to reduce the pressure on the trigeminal nerve or to affect the hypothalamus and pituitary glands which may be responsible for the “brainstorm” of nerve cell hyperactivity mentioned in the quote above (Luchau, Nov./Dec. 2010).
Regular massage may also increase serotonin levels in migraine sufferers and thus prevent recurrence. Serotonin is a neurotransmitter and low serotonin levels have been indicated in migraine sufferers. Low serotonin also causes depression, seasonal affective disorder, addictions and eating disorders.
Two other modalities that seem to reduce headache pain are Myofascial Release and Reiki. Myofascial Release used gentle, light traction and stretching to release the fascia, which is a single sheath of connective tissue that covers the muscles, bones, organs, and even the cells (everything!) inside your body. Craniosacral therapy and lymph drainage therapy always incorporate myofascial release as do other modalities, but it can be used as a “stand-alone” modality. Reiki is one of a number of energy modalities that can be used to work on the subtle energy body. In many cases, this gentle therapy alone can relieve the headache.
Massage has been proven in study after study to decrease the severity and frequency of headaches. When you see your therapist, be sure to tell her the following to help her determine the best therapy protocol for your specific needs:
Where your pain is located
How long you’ve had the pain and if it comes and goes
How often you have headaches in general
If you’ve seen a physician and if so, what is the diagnosis
What precipitated the headache if you know
What is the quality of the pain (dull, throbbing, stabbing)
How movement and sensory stimulus affect the pain levels
What you have done to relieve it, such as taking pain relievers or using cold compresses, before coming to her
Headaches do not have to be a fact of life. Self-care and regular massage can be of great help in preventing them and relieving them when they do occur.
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