EVOLUCIÓN: DEL I PLAN MUNICIPAL DE IGUALDAD AL II PLAN MUNICIPAL

According to craniosacral theory sacral dysfunction is likely to result from any cranial distortion or imbalance, although this concept is challenged by some authorities (see Chs 1 and 2 for discussion of the issues).

It is suggested that you now perform the exercises described below in order to evaluate your own findings regarding the claims and statements relative to synchronous cranial and sacral motion. Among the questions you might be asking yourself are:

• Can I sense sacral motion?

• Can I sense cranial and sacral motion synchronously?

• How does sacral function/motion relate to the individual's respiratory cycle?

• Does sacral motion seem to be independent of respiratory function?

Time suggested not less than 10 minutes Your model/patient may be supine, prone or sidelying (see Figs 6.15 and 6.16A-C). If supine, slide your dominant hand beneath the sacrum so that the fingertips rest at the base of the sacrum, spreading from one sacroiliac articulation to the other.

The coccyx should be gently cradled in the heel of the hand with the forearm and elbow resting comfortably on the surface of the treatment table.

Kneel or sit so that you are as comfortable as possible during the 10 minutes or so of this exercise. The free hand may be placed across the anterior pelvis so that the forearm rests on one ASIS and the hand on the other. This increases awareness of pelvic motion.

Figure 6.15 Sacral palpation, ideal hand position.

Figure 6.16 A,B Variations in patient and operator positions for sacral palpation and treatment. C Palpation of synchrony between occipital and sacral motion/

pulsation.

With eyes closed, focus attention to all sensations reaching the palpating hand on the sacrum.

Can you sense a rhythm synchronous with normal respiration? During the flexion (in-halation) phase of sacral and cranial motion the sacral apex is said to move anteriorly as the base moves posteriorly. These structures move back to their starting position during the exhalation (extension) phase.

If you sense these subtle movements ask the patient to hold her breath and observe what happens to the sacral motion at this time.

Is there still a subtle motion palpable as the breath is held?

As respiration resumes, try to sense whether or not this subtle motion alters again. Many craniosacral experts maintain that it is possible to learn to distinguish the motion related to breathing from a more subtle 'cranial respiratory' rhythm.

Record your findings after each performance of this and similar exercises.

If the subject is sidelying, the palpating hand is placed on the sacrum by taking it between the legs, as you sit in front facing the individual. In the prone position the hand is placed over the sacrum, fingers pointing cephalad.

Upledger & Vredevoogd (1983) make the following comments relative to numbness of hands when they are under the supine individual's sacrum: 'Pressure paraesthesia does not reduce proprioception; as a matter of fact, it enhances proprioceptive sensitivity somewhat by removing tactile noise. When the sacrum of the subject is supine on your hand, lean heavily upon your elbow, close your eyes and let your hand meld with the sacrum'.

Using a downward pressure on the elbow to enhance palpation sensitivity when the hand is under the palpating surface was a method devised by Rollin Becker (Becker 1963,1964,1965).

Time suggested 7-9 minutes

Philip Greenman (1989) suggests that your partner/model/patient lies on her side, pillow under the head in order to avoid any side-bending of the neck during this palpation. You should be seated behind and place one hand on the occiput (fingers going over the crown) and the other on the sacrum, fingers towards the coccyx (see Fig. 6.16C).

Upledger & Vredevoogd (1983), on the other hand, suggest palpating the motion in these bones simultaneously as the patient lies supine. If a normal synchronous motion is palpated they advocate slightly inhibiting the motion of either the occiput or the sacrum with one hand and noting the effect on the motion being perceived by the other hand. If, in the assessment, dural drag is presumed, due to a 'lag' between the occipital and sacral motions, they ask you to see whether you can tell whether this 'drag' is coming from one end or the other or from somewhere in between.

• Simultaneously palpate the motions of the occiput and the sacrum.

• Are they synchronous with each other and/or with respiratory function?

• What happens when the breath is held?

If peforming the palpation with your partner sidelying, once you have satisfied yourself of the answers to these questions (5 minutes should be ample), have your partner remove the pillow, so that the neck is sidebent.

Repalpate and compare the results.

• Can you feel the synchronous motions under your hands between occiput and sacrum?

• Are movements different from when the head was supported?

• If not, what changes occur when the neck is not supported on the cushion?

After performing this palpation several times, ask yourself whether or not you agree with Norton's statement (2002):

Exercise continues

There are no demonstrable temporal relationships between CRI rates of healthy human subjects measured simultaneously at the cranium and sacrum by two examiners, challenging the concept of craniosacral interaction through mechanical or functional linkages.

RECIPROCAL TENSION M E M B R A N E S AND THE V E N O U S S I N U S E S

The importance given to the relative balance and functional integrity of the reciprocal tension membranes is all too apparent in the literature.

Moskalenko et al (1999) have demonstrated that the falx cerebri, the falx cerebelli and the tentorium cerebelli are in a state of constant reciprocal tension and that the cranium tends to alternately expand laterally or in an AP or sagittal direction.

Greenman (1989) explains the importance to cranial circulation of this balanced tension, as follows.

Simply, the goal of craniosacral treatment is to restore balanced membranous tension. The normal dynamic reciprocal tension of the falx and tent cannot occur in the presence of restriction or alteration in the relationship of cranial bones.

Because of the relationship of the membranes to the venous sinuses within the skull [see Box 6.3], venous drainage cannot be enhanced if abnormal membranous tension persists.... Restoring maximum mobility to the osseous cranium allows the homeostatic mechanisms to restore balanced membranous tension, enhance venous flow, reduce neural entrapment and permit normal CRI rate, rhythm and amplitude.

See Figure 2.5A (p. 30) for an illustration of the relationship between the venous sinuses and the reciprocal tension membranes, falx cerebri and tentorium cerebelli and also Figure 6.17. See Box 6.3 for details of the venous sinuses.

Time suggested 10-15 minutes

This exercise describes a method commonly applied to enhance venous sinus drainage (see Fig. 6.17). Prior to its application the ducts and channels through which drainage is anti-cipated, including the thoracic outlet as well as the occipitoatlantal and cervical regions, are treated to prepare them for the cranial drainage.

Figure 6.17 Venous sinuses of the cranium.

Muscular insertions into the region should all receive attention, notably sternomastoid, rectus capitis and upper trapezius (details of suggested approaches to cranial muscular attachments are given in Ch. 9).

The patient is supine. The head rests on two, three or four fingers of one hand placed so that they are vertical to the table, pointing towards the ceiling in contact with the superior nuchal line close to the external occipital protuberances.

The weight of the head resting on the finger-pads is all the pressure required so that no additional force is applied by the hands or fingers. This position is maintained until a sense of warmth or 'softening' is noted in the tissues resting on the fingerpads.

It is recommended that this softening sensation should be felt as bilateral and equal before moving to the next position. The transverse sinus drains in response to this part of the sequence.

The fingers are now moved towards the foramen magnum where an identical position of the fingers is maintained until the softening response occurs to release the cerebellar sinus.

At this point the first position is readopted, with fingerpads on the external occipital pro-tuberances on the superior nuchal line but this time with one finger on the inion, until once again a 'softening' is noted. This is thought to release the confluence of the sinuses.

Two fingers are now placed on either side of the inion applying gentle separation force (ounces) on the occipital squama, while two fingers of the other hand apply a similarly mild pressure from a point contralaterally distant on the cranium, directed towards the fingers on each side of the inion. This contralateral point might be on the metopic suture of the frontal bone.

This process is called a V-spread and possibly has a disengaging effect on the reciprocal tension membranes associated with the areas being treated (or energy factors may be at play - see Ch. 2 and consider Smith's opinion, below). When a softening or 'fluid wave sensation' is noted this is considered to have influenced drainage from the sagittal sinus.

The head is now cradled in the palms of the hands with the thumbs placed one on each side of the sagittal suture, starting from a point just anterior to the lambda. The thumbs are moved progressively anterior after each softening sensation is noted until they reach the bregma at the coronal suture in order to influence the straight sinus.

The metopic suture of the frontal bone is treated by placing four fingers on either side of this suture, applying a mild separating pressure across the suture and waiting for softening to occur.

The metopic suture is said to remain patent in approximately one in five individuals.